Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP portable upright view of the chest provided . Left chest wall AICD is again seen with leads extending into the region of the right atrium and coronaries sinus . A prosthetic cardiac valve again noted . The heart remains massively enlarged . There is a small right pleural effusion . Mild congestion is noted without frank pulmonary edema . No pneumothorax . Bony structures are intact .
    OUTPUT:
    
Marked cardiomegaly with tiny right pleural effusion and mild hilar congestion .