Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again seen is severe cardiomegaly . There is marked pulmonary vascular redistribution with ill - defined vasculature and alveolar infiltrates left greater than right . There is a large left effusion and a small right effusion . There is volume loss in both lower lungs . Underlying infectious infiltrate can not be excluded . The ET tube , NG tube , and pacemaker are unchanged . The patient is status post valve replacement with sternotomy wires . The right - sided pigtail catheters again seen .
    OUTPUT:
    
1 . Increased CHF . 2 . Dense retrocardiac and lower lobe opacities . Can not exclude underlying infectious infiltrate .