Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral radiographs of the chest demonstrate moderate enlargement of the cardiac silhouette . The mediastinal silhouette and hilar contours are normal . The lungs are clear . No pleural effusion or pneumothorax .
    OUTPUT:
    
1 . Moderate enlargement of the cardiac silhouette could be due to pericardial effusion , recommend further evaluation with echocardiogram . 2 . No pneumonia Email sent to ED QA nurse with recommendation ___ as patient had already been discharged .