Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-upright AP view of the chest provided . The pacemaker is again seen projecting over the left chest wall with leads extending to the region of the right atrium and right ventricle . Midline sternotomy wires and mediastinal clips are again seen . The heart remains top normal in size . The lung volumes are quite low , which limits the evaluation primarily through the lower lungs . Allowing for this , there is no definite sign of pulmonary edema or pneumonia . No effusion or pneumothorax is seen . The bony structures are intact . No free air below the right hemidiaphragm .
    OUTPUT:
    
Limited , negative .