Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Single AP upright portable view of the chest was obtained . Dual - lead left - sided pacemaker is again seen with leads extending to the expected position of the right atrium and right ventricle , although the very inferior aspect of the right ventricular lead is not fully included on the image . Moderate cardiac silhouette enlargement persists . Mild central pulmonary vascular engorgement is again seen . No focal consolidation , pleural effusion , or pneumothorax is seen . Mediastinal contours are stable .
    OUTPUT:
    
Persistent moderate cardiomegaly and mild pulmonary vascular engorgement .