Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lung volumes are low . The cardiac silhouette is enlarged . Again noted is a tortuous aorta . In comparison to the priors , there is persistent pulmonary vascular congestion , possibly slightly progressed , though likely exaggerated due to low lung volumes . No definite pleural effusion or pneumothorax is identified , though the semi-upright technique limits evaluation . Again noted is a 2 lead left - sided pacemaker with the leads terminating in the right atrium and ventricle .
    OUTPUT:
    
Low lung volumes and persistent pulmonary vascular congestion .