Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: In comparison with the study of ___ , the Dobbhoff tube has been removed . The left subclavian catheter extends to the mid portion of the SVC . Ventriculoperitoneal shunt is again seen . The heart remains within normal limits in size and there is no vascular congestion or pleural effusion . Specifically , no acute focal pneumonia . The nodular density overlying the first rib in the right apex is unchanged from the study of ___ . It is unclear whether this represents a calcified granuloma or possibly a bone island in the first rib .
    OUTPUT:
    
No evidence of acute pneumonia .