Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is again a dual - lead pacemaker / ICD device with leads terminating in the right atrium and ventricle . The heart is again moderately enlarged . There is perhaps minimal similar upper zone redistribution of pulmonary vessels without frank pulmonary edema . Noting that the left hemidiaphragm is obscured by a pacer device , the area is not well evaluated , making it difficult to exclude a pleural effusion in particular . There is no evidence for pleural effusion on the right .
    OUTPUT:
    
Similar cardiomegaly . No evidence of acute cardiopulmonary disease .