Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP upright and lateral views of the chest provided . Overlying EKG leads are present . There is persistent cardiomegaly with hilar congestion and worsening pulmonary edema compared with prior radiograph . Bilateral pleural effusions are small to moderate in size . Difficult to exclude a superimposed pneumonia in the lower lungs given increased lower lung opacity . No large pneumothorax . Severe degenerative disease at both shoulders , right greater than left .
    OUTPUT:
    
Worsening pulmonary edema and pleural effusions , difficult to exclude a superimposed pneumonia in the lower lungs .