Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Dual lead left - sided pacemaker is again seen unchanged in position . There is moderate to marked enlargement of the cardiac silhouette . Patient is rotated to the left and there appears to be slight medialization of the calcification at the aortic knob . Left base opacity due to combination of pleural effusion and atelectasis in underlying consolidation not excluded . Pleural thickening is again seen along the right mid to lower chest .
    OUTPUT:
    
Large cardiac silhouette may be due to underlying cardiomyopathy and / or pericardial effusion . Left base opacity may be due to combination of pleural effusion and atelectasis , underlying consolidation not excluded . Apparent medialization of intimal calcification at the aortic knob , underlying dissection is not excluded . Recommend clinical correlation and consider chest CTA . These findings were discussed with Dr . ___ at 12 :00 via telephone on ___ , ___ min after discovery .