Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A dual lead left - sided pacemaker is seen with leads terminating in the right atrium and right ventricle , expected locations . The cardiac silhouette is again mild to moderately enlarged . The hilar and mediastinal contours are within normal limits . There is mild tortuosity of the descending aorta . The lungs are hyperinflated and there is some flattening of the diaphragms which may relate to COPD . There is no new focal consolidation , pleural effusion or pneumothorax .
    OUTPUT:
    
No acute cardiopulmonary process .