Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Severe cardiomegaly is unchanged . No change to the positioning of the left - sided pacer leads projecting over the right atrium and right ventricle . Elevation of the right hemidiaphragm is again noted . Hilar congestion again noted without overt pulmonary edema . Small pleural effusions are likely present . Bony structures appear intact .
    OUTPUT:
    
Marked cardiomegaly , hilar congestion with small pleural effusions .