Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Marked cardiomegaly is accompanied by pulmonary vascular congestion and diffuse interstitial edema . More confluent areas of opacification overlie the lower spine on the lateral view and or also present to a lesser extent in the right upper lobe . Small pleural effusions are present , left greater than right . Hyper expansion of the lungs is in keeping with history of COPD .
    OUTPUT:
    
Observed findings likely representing combination of congestive heart failure and aspiration pneumonia . Followup radiographs after diuresis may be helpful in distinguishing the contribution of each process to the observed abnormalities .