Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiac outline is severely enlarged . Calcifications are noted at the aortic arch . The lungs are clear with no evidence of consolidation , effusion , or pneumothorax . Blunting of bilateral costophrenic angles is again identified and may be due to pleural scarring .
    OUTPUT:
    
Severely enlarged cardiomediastinal silhouette . While this enlargement in comparison to prior study may be due to lower lung volumes , a pericardial effusion and myocarditis must be excluded in the proper clinical setting .