Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A left - sided chest wall pacer is noted with leads overlying the right atrium and ventricle , unchanged in their position . The cardiac size is difficult to approximate , but appears persistently enlarged . Interval increase in the degree of now moderate to severe pulmonary edema . Streaky bibasilar opacities likely reflect atelectasis , although superimposed infection is difficult to exclude . Bilateral moderate pleural effusions are noted , increased bilaterally from the prior examination .
    OUTPUT:
    
Persistent cardiomegaly with worsening of now moderate to severe pulmonary edema and moderate bilateral pleural effusions .