Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is severely enlarged , and is larger than on the prior study . There is no significant change in the tracheostomy tube or PICC line . There is marked improvement in the aeration in the right lower lobe , however there is some persistent alveolar infiltrate in the right lower lobe . The right heart border is very distinctly visualized suggesting that there may be a small amount of pneumomediastinum . The right effusion is decreased . There is increased obscuration of the left hemidiaphragm with dense retrocardiac opacity compatible with volume loss / infiltrate / effusion . This is worsened compared to the study from 2 days ago .
    OUTPUT:
    
Increased cardiomegaly , some improved aeration in the right lower lobe but worsened appearance to a left lower lobe . Sharp margin of the right heart border suggests an element of pneumomediastinum