Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiac silhouette is increased in size , now severely enlarged . There is a left pectoral cardiac device with its leads in unchanged position projecting over the right atrium and ventricle . The patient is status post median sternotomy and coronary artery bypass . There is mild central vascular congestion without overt pulmonary edema . There is no pleural effusion or pneumothorax .
    OUTPUT:
    
Severe enlargement of the cardiac silhouette , slightly more so when compared to ___ . This could be due to cardiomegaly although possibility of pericardial effusion could also be considered . Mild vascular congestion .