Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Tracheostomy tube is in standard position , terminating approximately 5 .4 cm from the carina . Lung volumes are low . Moderate to severe enlargement of the cardiac silhouette is demonstrated . The mediastinal contours are unremarkable . Mild pulmonary vascular congestion is demonstrated with vascular indistinctness and cephalization of vasculature . Retrocardiac opacity may reflect atelectasis . No large pleural effusion or pneumothorax is present however the left costophrenic angle is excluded from the field of view . Multilevel moderate degenerative changes are seen in the thoracic spine . There are no acute osseous abnormalities .
    OUTPUT:
    
Moderate to severe cardiomegaly with mild pulmonary vascular congestion . Retrocardiac opacity may reflect atelectasis , but infection is not excluded . Followup radiographs after diuresis are recommended .