Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP upright and lateral views of the chest provided . Abandoned pacer leads again seen projecting over the right chest wall extending into the heart . There is a left chest wall pacemaker with leads extending into the coronary sinus , right atrium and right ventricle . Fibrotic changes are again noted most prominent in the lower lungs , left greater than right . No convincing signs of a superimposed pneumonia . Calcified pleural plaque projects over the right hemi thorax as seen on prior CT chest . No pneumothorax . Cardiomediastinal silhouette is stable . Bony structures are intact .
    OUTPUT:
    
Pulmonary fibrosis , similar in overall pattern to prior exam . Calcified pleural plaque . Pacemaker in place .