Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Dual lead left - sided AICD is again seen , similar in appearance as compared to the prior study . The cardiac silhouette is quite enlarged , although stable . Prominence and indistinctness of the hila and other pulmonary vessels consistent with moderate pulmonary edema , slightly worsened as compared to the prior study . Pleural effusions , if any , are small . No pneumothorax is seen .
    OUTPUT:
    
Persistent severe enlargement of the cardiac silhouette . Moderate pulmonary edema , somewhat worse compared to the prior study .