Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP single view of the chest was obtained with patient in sitting semi-upright position . Analysis is performed in direct comparison with the next preceding similar study of ___ . Marked cardiomegaly as before . Permanent pacer in left axillary position with two intracavitary electrodes . Their position corresponds to the apical portion of the right ventricle and right atrial appendage respectively . The position of the electrodes indicates marked widening of the right atrium . The pulmonary vasculature is now again more congested than on the next previous examination , and in addition , the lateral pleural sinuses are now again blunted indicating bilateral pleural effusions . A diffuse hazy _____ density overlying the right lower - most lung field is suspicious for some infiltrate , and additional aspiration pneumonitis should be considered .
    OUTPUT:
    
Reoccurrence of severe CHF with pulmonary congestion and now bilateral pleural effusion . The findings are not _____ similar to what was found on the first examination of ___ , but the patient had a temporary episode of improvement on the next preceding study of ___ .