Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left chest wall dual lead pacing device is again seen . The lungs are now clear . There is no effusion or vascular congestion . The cardiomediastinal silhouette is within normal limits . Median sternotomy wires and mediastinal clips are again seen . Hypertrophic changes seen in the spine without acute osseous abnormality .
    OUTPUT:
    
No acute cardiopulmonary process .