Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right subclavian PICC ends in lower SVC . Left pectoral pacemaker has two leads following the expected course and ending in right atrium and right ventricle . Sternotomy metal wires are intact and along the midline . Lung is fully expanded and clear , there are no signs of vascular congestion or pulmonary edema . There is no pleural effusion or pneumothorax . Severe cardiomegaly including large calcified left ventricular aneurysm is unchanged .
    OUTPUT:
    
No changes since ___ , in particular no sign of vascular congestion or pulmonary edema .