Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiac silhouette is massively enlarged , substantially increased since the prior study concerning for a large pericardial effusion . There may be trace bilateral pleural effusions . Left lower lobe consolidation is difficult to exclude . Right - sided pacer device is again noted .
    OUTPUT:
    
Massive enlargement of the cardiac silhouette , substantially increased as compared to the prior study from ___ , concerning for large pericardial effusion . Possible trace bilateral pleural effusions .