Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are clear without focal consolidation , effusion , or pulmonary edema . Enlarged cardiac silhouette is as on prior likely due to combination of cardiomegaly and pericardial effusion . No acute osseous abnormalities identified , although sclerosis of the vertebral bodies is again noted suggesting secondary hyperparathyroidism .
    OUTPUT:
    
No acute cardiopulmonary process .