Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The radiograph is underpenetrated , limiting evaluation . There is moderate - to - severe cardiomegaly with slightly increased right ventricular predominance compared to the prior examination . There is more prominent pulmonary vascular engorgement compared to the prior study . A region of band - like opacity in the right upper lobe obscures the right mediastinal contour . The lung bases are difficult to evaluate due to limitations in technique , and an underlying effusion or consolidation can not be excluded . There is no pneumothorax .
    OUTPUT:
    
1 . Moderate - to - severe cardiomegaly , with more prominent right atrial dilation , accompanied by pulmonary vascular engorgement is concerning for congestive heart failure . 2 . Possible right upper lobe pneumonia . Evaluation with PA and lateral radiographs is recommended for more optimal evaluation .