Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pacer device is again noted with leads terminating in the right atrium and right ventricle . Moderate enlargement of the cardiac silhouette persists . The mediastinal and hilar contours are similar . Pulmonary vasculature is not engorged . Lungs are hyperinflated with emphysematous changes again noted . Patchy opacities within the lung bases without substantial interval change , likely atelectasis , without focal consolidation . No pleural effusion or pneumothorax is demonstrated . Mild to moderate degenerative changes are seen in the thoracic spine .
    OUTPUT:
    
No substantial interval change from the previous radiograph with continued emphysema and patchy bibasilar opacities , likely atelectasis , without focal consolidation .