Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Enlargement of the cardiomediastinal silhouette is grossly similar to prior studies given differences in technique and inspiration . Left - sided pacer device is similar in position . No definite focal consolidation is seen . There is no pleural effusion . No evidence of pneumothorax is seen . No overt pulmonary edema is seen .
    OUTPUT:
    
Enlargement of the cardiomediastinal silhouette again seen . No focal consolidation to suggest pneumonia .