Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: ET tube tip approximately 4 .4 cm above the carina , at the level of the mid clavicular heads . NG tube not well seen through the lower mediastinum , though it appears to extend beneath the diaphragm , off the film . Right IJ central line is unchanged , with tip at cavoatrial junction . No pneumothorax detected . Again seen are extensive nodular and confluent opacities in both lungs , most pronounced along the periphery of the right lung . Right and left costophrenic angles are both obscured , suggesting bilateral pleural effusions . The cardiomediastinal silhouette is unchanged .
    OUTPUT:
    
Compared with 1 day earlier , I doubt significant interval change . Extensive bilateral opacities consistent with ARDS again seen .