Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Dual lead left chest wall pacing device is again seen . Massive enlargement of the cardiac silhouette is as on prior . Indistinct pulmonary vascular markings are seen on the current exam . Small right - sided pleural effusion is apparently new . Increased soft tissue density at the thoracic inlet with rightward deviation of the trachea is compatible with known left - sided thyroid enlargement . Focal opacity projecting over the right anterior third rib is more conspicuous on today 's exam .
    OUTPUT:
    
Massive cardiomegaly . Interstitial edema and small right effusion . Focal opacity projecting over the right third rib potentially due to edema but followup after treatment is suggested to document resolution .