Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP single view of the chest has been obtained with patient in sitting semi-upright position . A status post sternotomy and the presence of surgical clips to the left of the midline is suggestive of a previous bypass surgery . There is marked cardiac enlargement . The thoracic aorta is generally widened and elongated . A permanent pacer is identified in left anterior axillary position connected to a single intracavitary electrode terminating in a position compatible with the apical portion of the right ventricle . The pulmonary vasculature is distended and demonstrates significant perivascular haze predominantly on the bases . Mild blunting of the lateral pleural sinuses suggests the beginning development of pleural effusion . There is no evidence of pneumothorax and no evidence of discrete local pulmonary parenchymal infiltrates . Large presence can of course not be excluded in the lung bases that are secured by the cardiac enlargement and the high positioned diaphragms . Our records do not include a previous chest examination . Referring physician ___ was paged at 4 p .m .
    OUTPUT:
    
Status post bypass surgery and permanent pacer , marked cardiomegaly and severe CHF . No conclusive evidence for pneumothorax .