Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Status post placement of permanent pacemarker with both pacing leads terminate to the left of midline , with the more distal lead in the expected location of the right ventricle . The prior CTA of the chest demonstrates baseline rotation and shift of the heart towards the left , causing the right atrium to project slightly to the left of midline , likely accounting for the location of the proximal lead on today 's chest radiograph . Cardiac silhouette remains enlarged , and the left hemidiaphragm is chronically mildly elevated . Blunting of left costophrenic sulcus appears to be due to a combination of cardiac enlargement and pericardial fat in this region as based on prior CTA of the chest . Exam is otherwise remarkable for 1 .2 cm diameter opacity overlying the left third anterior rib level .
    OUTPUT:
    
1 . Pacing leads probably terminate in right atrium and right ventricle based on correlation with chest CTA of ___ , but confirmatory lateral radiograph would be helpful in this regard when the patient 's condition allows . There is no evidence of pneumothorax . 2 . 1 .2 cm diameter opacity at left third rib level , possibly a healed rib fracture , but attention to this finding on a followup PA and lateral radiograph would be helpful to exclude a discrete lung nodule . Dr . ___ has been notified of this finding by telephone at 8 :30 a .m . on ___ at the time of discovery .