Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left chest wall dual lead pacer is again seen . There has been significant enlargement of the cardiac silhouette since ___ with suggestion of a fat pad sign on the lateral view , suspicious for pericardial effusion . The lungs are clear . Mild blunting of the posterior costophrenic angles is new and could represent trace effusions . No acute osseous abnormalities .
    OUTPUT:
    
Significant interval enlargement of the cardiac silhouette since ___ most suspicious for pericardial effusion .