Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left chest wall dual lead pacing device is again seen . Relative elevation of the right hemidiaphragm is again noted . The lungs are clear of consolidation , effusion , or vascular congestion . Aortic core valve is again noted . No acute osseous abnormalities identified , hypertrophic changes again noted in the spine .
    OUTPUT:
    
No acute cardiopulmonary process .