Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left sided dual - chamber AICD / pacemaker device is noted with leads terminating in the right atrium and right ventricle , unchanged . Severe enlargement of the cardiac silhouette is re - demonstrated , compatible with cardiomegaly and a moderate to large pleural effusion . Mediastinal and hilar contours appear relatively unchanged . There is a new focal opacity within the right upper lung field . Additionally there is mild pulmonary edema , with small bilateral pleural effusions , slightly progressed in the interval . Assessment of the lung apices is limited due to obscuration by the patient 's chin . No large pneumothorax is identified but assessment is limited . There are no acute osseous abnormalities .
    OUTPUT:
    
1 . Focal opacity within the right upper lung field likely reflects pneumonia though asymmetric pulmonary edema may have a similar appearance . 2 . There is a background of mild pulmonary edema which appear slightly progressed compared to the prior study with small bilateral pleural effusions . 3 . Enlargement of the cardiac silhouette is compatible with a combination of cardiomegaly and moderate to large pericardial effusion .