Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: ET tube tip lies approximately 4 .5 cm above the carina . An NG tube is present , tip extending beneath diaphragm , off film . Left IJ central line tip overlies the mid SVC . No pneumothorax is detected . Slightly rotated positioning . Allowing for this , cardiomediastinal enlargement appears similar to prior . The patient has a known ascending aortic aneurysm . Sternotomy wires again seen . The patient has mitral and tricuspid valve replacements . There are extensive opacities throughout both lungs . This appears to reflect the presence of CHF with interstitial and alveolar edema , however , the presence of background infectious infiltrates would be difficult to exclude in this setting . There is persistent left lower lobe collapse and / or consolidation and a probable small left effusion , similar to prior . Previously seen small right effusion is less apparent on this exam , though could still be present .
    OUTPUT:
    
Cardiomegaly , unchanged . Left lower lobe collapse and / or consolidation and small left effusion are similar to the prior study . Extensive bilateral infiltrates . These appear more pronounced compared with the prior film , but are also likely accentuated by differences in technique . This could represent CHF , but underlying pneumonic infiltrates can not be excluded . No gross right effusion , though a small effusion might not be apparent .