Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Elevated right hemidiaphragm again noted . The heart is markedly enlarged with splaying of the carinal suggesting left atrial enlargement . Given lack of prior imaging studies , difficult to assess the the of the cardiac enlargement and clinical correlation for possibility of pericardial effusion advised . No large effusion or pneumothorax . No convincing signs of pneumonia or edema . The mediastinum appears well - defined and mildly prominent likely reflecting a ectatic vasculature . The bony structures are diffusely demineralized with high riding humeral heads noted bilaterally .
    OUTPUT:
    
Marked cardiomegaly . Please correlate clinically for chronicity and possibility of pericardial effusion . No evidence of pneumonia .