Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lung volumes are diminished which exaggerates the cardiomediastinal configuration . However , even accounting for this change , there has been a relative dramatic increase in the size of the cardiac silhouette with now somewhat globular morphology . Ill - defined opacity is noted in the retrocardiac left lower lobe which is likely atelectasis given the volume loss . There is no focal consolidation . No definite effusion or pneumothorax is seen . The osseous structures are unremarkable . Incidental note is made of internal fixation hardware , incompletely evaluated , involving the mid diaphysis of the right clavicle . Tubing loops over the epigastric region and with the tip projecting at the dome of the left hemidiaphragm over the cardiac silhouette .
    OUTPUT:
    
Interval enlargement of the cardiac silhouette even accounting for patient and technical factors . This likely signifies at least an increase in the size of the apparently known pericardial effusion .