Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP single view of the chest has been obtained with patient in upright position . Comparison is made with the next preceding portable chest examination obtained 10 hours earlier during the same day with patient in supine position . Again , there is significant cardiac enlargement in this patient with a permanent pacer in left anterior axillary position and a single intracavitary electrode terminating in a position compatible with apical portion of right ventricle . There is significant cardiac enlargement as before . The configuration includes a prominence of the left atrial appendage contour resulting in a straightening of the left heart border rather typical for left atrial enlargement . Pulmonary vasculature is still congested but less so than on the preceding supine examination . On this image obtained with patient in upright position , there is no evidence of significant pleural effusion accumulating in the lateral pleural sinuses . No new acute parenchymal infiltrates can be seen . There is no evidence of pneumothorax in the apical area .
    OUTPUT:
    
___-year - old male patient with acute stroke . Cardiac enlargement including prominence of left atrial contours suggestive of mitral valve disease . An echocardiographic examination is recommended .