Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Moderate enlargement of the cardiac silhouette has increased substantially since ___ . Severe distension of mediastinal veins is disproportionate compared to mild pulmonary vascular congestion , pointing toward right heart failure or hemodynamically significant pericardial effusion . Lungs are clear and there is no pleural effusion .
    OUTPUT:
    
Worse cardiomegaly and / or pericardial effusion . Suggest echocardiography . Dr ___ paged at 8 :30 AM .