Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Patient is status post median sternotomy . Dual lead left - sided AICD is seen with 1 lead extending to the expected location of the right ventricle . The more proximal lead appears to extend to the right atrium however , appears changed in orientation as compared to the prior study , now pointing more to the right . This was discussed with Dr . ___ ___ : 30 on ___ via telephone . The cardiac silhouette remains markedly enlarged . Mediastinal contours are stable . There is moderate central pulmonary vascular congestion . No pleural effusion is seen . There is no pneumothorax .
    OUTPUT:
    
Right the atrial lead appears to have moved in position as compared to the prior study , now pointing more to the right , and setting superiorly . Persistent marked enlargement of the cardiac silhouette . Moderate central pulmonary vascular congestion .