Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is again a three - lead pacemaker / ICD device with leads terminating in the right atrium , right ventricle , and coronary sinus . The cardiac , mediastinal and hilar contours appear unchanged including mild - to - moderate cardiomegaly and moderate unfolding of the thoracic aorta . Similar to prior findings , there is upper zone redistribution of pulmonary vasculature and peribronchial cuffing suggesting a state of very mild vascular congestion . There is no definite pleural effusion or pneumothorax . There has been little if any change .
    OUTPUT:
    
Stable appearance of the chest .