Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: 2 lead left - sided pacemaker is again seen with lead extending to the expected positions of the right atrium and right ventricle . The cardiac silhouette remains enlarged . Mediastinal contours are grossly stable . There may be minimal central pulmonary vascular engorgement without overt pulmonary edema . No focal consolidation , pleural effusion , or evidence of pneumothorax is seen .
    OUTPUT:
    
Possible minimal central pulmonary vascular engorgement without overt pulmonary edema . Persistent enlargement of the cardiac silhouette .