Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There is moderate to severe enlargement of the cardiac silhouette , increased since prior exam in ___ , which may be due to worsening cardiomyopathy or pericardial effusion . The mitral valve annulus is extensively calcified . The aorta is tortuous with calcifications seen at the arch . Mild blunting of the right costophrenic angle likely represents a small pleural effusion . Lungs are hyperinflated but otherwise clear . No pulmonary edema is present . Severe degenerative changes are seen in the bilateral shoulders with chronic appearing subluxation , as well as within the imaged thoracolumbar spine .
    OUTPUT:
    
1 . Moderate to severe enlargement of the cardiac silhouette , increased since prior exam in ___ , may be due to worsening cardiomyopathy or the presence of a pericardial effusion . 2 . Small right pleural effusion . 3 . Severe degenerative changes of the bilateral shoulders and thoracolumbar spine .