Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest are provided . There is severe cardiomegaly , which has increased over multiple prior radiographs . Midline sternotomy wires are again noted . Slightly elevated left hemidiaphragm is again noted with probable small effusion on the left . Retrocardiac atelectasis is also likely present . Right lung is clear . No pneumothorax . Bony structures are intact .
    OUTPUT:
    
Cardiomegaly with elevated left hemidiaphragm , left lower lobe atelectasis and possible small left effusion . Please correlate clinically and with echocardiogram as pericardial effusion is a strong concern .