Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Compared with the prior study and allowing for technical differences , no definite change . Again seen is left - sided pacemaker with lead tips over the right atrium and right ventricle , sternotomy wires , and prosthetic tricuspid and mitral valves . Unusual configuration of wires over the superior mediastinum is unchanged compared with ___ in appears to reflect the presence of a sternal defect . Again seen is cardiomegaly and CHF , with vascular plethora and interstitial edema . There is bibasilar atelectasis , similar to prior . No gross effusion . As before , the pulmonary arteries are enlarged , suggestive of pulmonary hypertension . Incidental note is again made of deformity of the right humeral head , which may reflect an old fracture .
    OUTPUT:
    
Cardiomegaly with CHF and bibasilar atelectasis , similar to ___ . No effusions identified .