Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP and lateral radiographs were acquired . There is a left - sided pacemaker with an associated right ventricular lead , appropriately positioned . The lungs are hyperexpanded and there is flattening of the hemidiaphragms with enlargement of the retrosternal airspace , consistent with chronic obstructive pulmonary disease . There is a right lower lung granuloma , as before . The lungs are otherwise clear . The heart size is top normal . The mediastinal contours are normal . There are no pleural effusions . No pneumothorax is seen .
    OUTPUT:
    
1 . No acute process . 2 . Findings consistent with chronic obstructive pulmonary disease .