Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Rotated positioning . As before , there is cardiomegaly . Direct comparison for any increase in cardiac size is difficult due to rotated positioning and technical differences . The possibility of some interval increase in the degree of cardiac enlargement can not be excluded . As before , as well , the aorta is calcified and unfolded . There is a possible small right effusion as well as some atelectasis and scarring at the right base superimposed on a known elevated right hemidiaphragm . Possibility of some interval worsening of these findings can not be excluded . There is new increased retrocardiac density with obscuration of the left hemidiaphragm , consistent with left lower lobe collapse and / or consolidation . No gross left effusion . Left apical pleural thickening is more apparent on the current film .
    OUTPUT:
    
Allowing for technical differences , there is new left lower lobe collapse and / or consolidation and possible new opacity at the right base , with equivocal small right effusion . Differential diagnosis includes pneumonia and aspiration . Possibility of some degree of CHF superimposed on existing background COPD would also be difficult to exclude .