Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Atrioventricular pacemaker with leads terminating in the right atrium and right ventricle . Top normal heart size . The lung volumes are normal . Normal size of the cardiac silhouette . Normal hilar and mediastinal structures . . No pneumonia , no pulmonary edema . No pleural effusions . No rib fractures seen .
    OUTPUT:
    
Normal chest radiograph without rib fractures . If high clinical concern for rib fractures . , consider decided rib radiographs .