Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Severe cardiomegaly is again noted , similar when compared to prior . Left chest wall dual lead pacing device is again noted . The lungs are clear without focal consolidation , effusion , or pulmonary edema . No acute osseous abnormalities .
    OUTPUT:
    
Cardiomegaly without superimposed acute cardiopulmonary process .