Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is a moderate to severe cardiomegaly without vascular congestion . The lungs , pleura and mediastinal contours are unremarkable .
    OUTPUT:
    
Moderate to severe cardiomegaly without vascular congestion , suggesting the possibility of a pericardial effusion or cardiomyopathy . The lungs are clear bilaterally .