Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP portable upright view of the chest . Dual lead pacemaker is unchanged . The heart remains moderately enlarged . Mitral annular calcifications are again suggested . There is aortic atherosclerosis is again noted . The lungs appear grossly clear without supine evidence for effusion or pneumothorax . Chronic left ribcage deformities are again noted . No acute osseous abnormality . Vertebroplasty changes in the thoracolumbar junction again noted .
    OUTPUT:
    
Cardiomegaly without acute intrathoracic process .