Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Dual lead pacemaker in situ with the lead tip seen in the right atrium and right ventricle . Evidence of previous CABG procedure with sternal wires unchanged . Evidence of previous cervical spinal fusion . Marked pulmonary hyperinflation . No suspicious pulmonary nodule or mass . Marked peripheral pruning of blood vessels . Spondylotic changes of the thoracic spine .
    OUTPUT:
    
Marked COPD . No pneumonia . No suspicious pulmonary nodule or mass .