Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Dual lead left - sided pacer is seen with leads extending the expected positions of the right atrium right ventricle . The cardiac silhouette is moderately enlarged . Central pulmonary vascular engorgement and moderate pulmonary vascular congestion are seen . There may be very trace pleural effusion but no large pleural effusion is seen .
    OUTPUT:
    
Possible trace pleural effusion , but no large pleural effusion . Moderate cardiomegaly and moderate pulmonary vascular congestion .