Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest were obtained . Midline sternotomy wires , mediastinal clips are again noted . A dual - lead pacer projects over the left chest wall with lead tips ascending into the expected location of the right atrium and right ventricle , unchanged . The heart is mildly enlarged . There are flattened diaphragms , which could reflect COPD . Coarsened lung markings could reflect underlying emphysema , though the possibility of mild congestion is impossible to exclude . There is no frank pulmonary edema or definite signs of pneumonia . Mediastinal contour is stable with unfolded thoracic aorta with atherosclerotic calcifications noted . The imaged osseous structures appear intact .
    OUTPUT:
    
Mild cardiomegaly . COPD with coarsened interstitial markings , possibly reflecting emphysema , though mild congestion impossible to exclude .