Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a new single - lead pacemaker device which has been placed since the earlier examination , with its lead terminating in the right ventricle . A punctate hyperdense focus in the anterior mediastinum to the right of midline appears unchanged . The heart is again mildly enlarged . The mediastinal and hilar contours appear unchanged . A mild diffuse interstitial abnormality is quite similar to the prior examination . There is no pleural effusion or pneumothorax . The lungs are hyperinflated . Bony demineralization and mild degenerative changes along the thoracolumbar spine , including prominent anterior osteophytes along a few lower thoracic interspaces , appear unchanged . The patient is status post incompletely imaged left shoulder replacement .
    OUTPUT:
    
Stable appearance of the chest including a widespread mild - to - moderate interstitial abnormality . Differential considerations include chronic pulmonary vascular congestion or an intrinsic interstitial abnormality .