Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest provided . Dual - lead pacer is unchanged . Midline sternotomy wires and mediastinal clips are again seen . Cardiomegaly is again noted with bilateral pleural effusions , increased on the right . Pulmonary edema persists . No pneumothorax . Bony structures are intact .
    OUTPUT:
    
Pulmonary edema with bilateral pleural effusion and cardiomegaly .