Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size is normal . The mediastinal and hilar contours are normal . The pulmonary vasculature is normal . Lungs are clear . No pleural effusion or pneumothorax is seen . There are no acute osseous abnormalities .
    OUTPUT:
    
Left - sided dual - chamber pacemaker device with leads terminating in the right atrium and right ventricle is re - demonstrated , unchanged . Mild cardiomegaly is increased in size compared to the previous exam . The mediastinal and hilar contours are unchanged . Lungs are hyperinflated with attenuation of the pulmonary vascular markings towards the apices suggestive of underlying emphysema / COPD . No pulmonary vascular congestion is demonstrated . No focal consolidation , pleural effusion or pneumothorax is seen . There are no acute osseous abnormalities .