Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal view of the chest demonstrates persistent severe enlargement of the cardiac silhouette , which may represent pericardial effusion . There is no focal pneumonia , pleural effusion , or pneumothorax . Minimal pulmonary vascular congestion is unchanged from prior study .
    OUTPUT:
    
Persistent severe enlargement of the cardiac silhouette may represent pericardial effusion . No focal pneumonia , pleural effusion , or pneumothorax . Otherwise , unchanged since the prior study . The above findings were communicated to Dr . ___ by Dr . ___ ___ ___ at the time of discovery .