Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left chest wall single lead pacing device is again noted . Lungs are clear . The cardiac silhouette is moderate to severely enlarged as on prior . The mediastinal and hilar contours are unremarkable . No acute osseous abnormalities identified .
    OUTPUT:
    
Cardiomegaly without superimposed acute cardiopulmonary process .