Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient 's neck is flexed and head obstructs portions of the apical lung regions and anterior mediastinum . There is severe new cardiomegaly with no clear evidence of failure . Left - sided pacer is seen with leads terminating within the right atrium and right ventricle with no obvious complications . There are apparent peripheral interstitial reticular opacities which could reflect chronic scarring . There is no pleural effusion or pneumothorax . The aorta is mildly calcified . Seen on the left side are at least two contiguous rib fractures ( approximately the ___ and ___ lateral rib level ) with an adjacent well - demarcated opacity with incomplete borders , which could represent either a pleural or an extrapleural mass .
    OUTPUT:
    
1 ) Left rib fractures with adjacent opacity concerning for either pleural or extrapleural mass . In the context of melanoma , this finding raises the concern for possible metastasis . CT or dedicated rib series may be considered if warranted clinically . 2 ) Marked cardiomegaly with no evidence of acute CHF . These findings were discussed with Dr . ___ at 3 :25 p .m . via ___ as requested by the ordering physician .