Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-erect chest film ___ at 23 : 17 is submitted .
    OUTPUT:
    
There has been prior median sternotomy with valve replacement . Overall cardiac and mediastinal contours are stably enlarged . Lungs appear relatively well inflated without evidence of focal airspace consolidation to suggest pneumonia . No pulmonary edema . No pneumothorax . No large effusions . Dense nodular opacity at the right apex is stable since ___ and most likely represents a granuloma . Old right posterior lateral rib fractures . No acute bony abnormality appreciated .