Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Midline tracheostomy tube is again seen . Left - sided pacer device is again seen with leads unchanged in position of the distal aspect of the lead is not well seen due to under penetration . The patient is status post median sternotomy and cardiac valve replacement . The cardiac silhouette remains markedly enlarged . The mediastinal contours are stable , as are the hilar contours . There are likely small bilateral pleural effusion with overlying atelectasis . Moderate pulmonary edema is seen . Right - sided PICC is again seen , unchanged in position .
    OUTPUT:
    
Persistent marked enlargement of the cardiac silhouette . Moderate pulmonary edema and likely small bilateral pleural effusions .