Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Triple - lead left - sided AICD is again seen , unchanged in position , with leads extending in the expected positions of the right atrium , right ventricle , and coronary sinus . The cardiomediastinal silhouette remains stably enlarged . Again , there is mild indistinctness of the pulmonary vessels , raising the possibility of elevated pulmonary venous pressure . No large pleural effusion or pneumothorax is seen . No definite focal consolidation .
    OUTPUT:
    
Persistent enlargement of the cardiomediastinal silhouette and possible mild pulmonary vascular congestion . The cardiac silhouette size is markedly out of proportion to the degree of vascular congestion , raising the possibility of cardiomyopathy or possible pericardial effusion , although appearance is stable compared to prior .