Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest were obtained . Dual - lead left - sided pacemaker is again seen with leads extending to the expected positions of the right atrium and right ventricle . The cardiac silhouette is moderate to severely enlarged . Aortic knob remains calcified . No focal consolidation , large pleural effusion , or evidence of pneumothorax is seen . Trace pleural effusions would be difficult to exclude . There is minimal interstitial edema .
    OUTPUT:
    
Markedly enlarged cardiac silhouette again seen with minimal interstitial edema .