Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Massive enlargement of the cardiac silhouette size has increased in size compared to the previous exam and is concerning for increasing pericardial effusion . A large hiatal hernia is again seen . The lung volumes are low with crowding of the bronchovascular structures and probable mild pulmonary vascular congestion but no overt pulmonary edema . Patchy bibasilar airspace opacities may reflect atelectasis , but infection can not be completely excluded . There are likely small bilateral pleural effusions . No pneumothorax is identified . There are degenerative changes noted in both glenohumeral and acromioclavicular joints with narrowed acromiohumeral intervals suggestive of underlying rotator cuff disease . Left - sided dual - chamber pacemaker device with leads terminating in the right atrium and right ventricle remains in unchanged position .
    OUTPUT:
    
Massive enlargement of the cardiac silhouette which has increased in size , concerning for increasing pericardial effusion . Probable small pericardial effusions and bibasilar opacities likely reflecting atelectasis , but infection can not be completely excluded .