Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Triple lead left - sided AICD is again seen with leads in the expected positions of the right ventricle , coronary sinus , and right atrium . The cardiac silhouette is markedly enlarged . The size of the cardiac silhouette appears increased as compared to the prior study although this may in part relate to a AP , portable technique . There is prominence of the hila and central pulmonary vasculature suggesting vascular engorgement and pulmonary vascular congestion with possible mild edema . . No large pleural effusion is seen . There is no evidence of pneumothorax .
    OUTPUT:
    
Marked enlargement of the cardiac silhouette , appears increased in size compared the prior study , however , this may relate to AP , portable technique . Underlying cardiomyopathy or pericardial effusion not excluded . Central pulmonary vascular engorgement , pulmonary vascular congestion .