Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a dual - lead pacemaker / ICD device with leads again terminating in the right atrium and ventricle , respectively . The heart appears mildly enlarged . The mediastinal and hilar contours appear unchanged . The lungs appear clear . Moderate degenerative changes involve the right acromioclavicular joint .
    OUTPUT:
    
No evidence of acute disease .