Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-erect chest radiograph ___ at 03 :35 is submitted .
    OUTPUT:
    
The patient is markedly rotated limiting evaluation of the cardiac and mediastinal contours . However , the heart does appear mildly enlarged which may reflect cardiomegaly , although pericardial effusion should also be considered . Lungs appear relatively well inflated with streaky opacities at both bases likely reflecting atelectasis . No evidence of pulmonary edema . No large effusions or pneumothoraces . Bilateral shoulder replacements .