Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest were obtained . The patient is status post median sternotomy . Dual - lead left - sided pacer device is again seen , with one lead extending to the expected position of the right atrium . The second lead which extends more inferior is not well evaluated due to underpenetration . There are relatively low lung volumes . The cardiac enlargement persists , although appears minimally less prominent as compared to the prior study . No definite pleural effusion is seen . There is minimal central pulmonary vascular congestion . Evidence of DISH is seen along the spine .
    OUTPUT:
    
Continued enlargement of the cardiac silhouette with mild vascular congestion .