Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral chest views were obtained with patient in upright position . Comparison is made with the next preceding similar study of ___ . The patient is status post sternotomy and the presence of multiple surgical clips are indicative of preceding bypass surgery . The heart size has not changed significantly . Observed is the removal of a previously present wide caliber dialysis catheter entered via the right internal jugular approach . No pneumothorax has developed . Pulmonary vasculature is not congested and no new acute or chronic parenchymal infiltrates can be seen . Lateral and posterior pleural sinuses are free . When comparison is made with a preceding examination , there is no evidence of any new rib abnormality such as non-displaced fissure or other rib deformity .
    OUTPUT:
    
Standard views PA and lateral chest x-ray do not disclose any new pulmonary or cardiovascular abnormality . As there is no evidence of pneumothorax , new pleural effusions or parenchymal abnormalities , the identification of local rib injuries could be performed by identifying the area of distinct local discomfort and to perform dedicated skeletal radiographs .