Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Permanent pacemaker is present with leads in the right atrium and right ventricle . Heart is upper limits of normal in size . Considering apical lordotic projection . Pulmonary vascularity is normal , and lungs are grossly clear . Thoracic aorta is tortuous and calcified . There are no pleural effusions . Right shoulder prosthesis is incidentally noted and is difficult to assess due to patient positioning .
    OUTPUT:
    
No evidence of pneumonia or congestive heart failure .