Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Median sternotomy wires are intact . Left chest wall pacer - defibrillator has leads terminating in the right atrium and right ventricle . Heart size is increased notably with increased size of the right atrium . There is chronic blunting of the right costophrenic sulcus the lungs are otherwise clear . No pneumothorax . No pulmonary edema .
    OUTPUT:
    
Worsening moderate cardiomegaly . No frank pulmonary edema or evidence of pneumonia .