Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A pacemaker / ICD device has two ventricular leads and a single right atrial lead . The device projects over the right upper hemithorax . The heart is moderate - to - severely enlarged . The main pulmonary artery contour is prominent . The aortic arch is calcified . The diaphragmatic contour on the left is indistinct but the significance is difficult to judge given cardiomegaly . The lungs are difficult to assess in this area and it is also difficult to exclude a small left - sided pleural effusion . However , there is no evidence for pleural effusion on the right . Otherwise , aside from streaky lingular atelectasis , the visualized lungs appear clear . Mild rightward convex is curvature centered along the mid thoracic spine . Surgical clips project along the left axilla .
    OUTPUT:
    
Somewhat limited examination , but substantial cardiomegaly without definite evidence for acute disease .