Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Cardiac silhouette is enlarged similar to prior . There is central pulmonary vascular engorgement and indistinct pulmonary vascular markings . There is no pleural effusion or focal consolidation . Degenerative changes partially visualized at the shoulders bilaterally . In addition , there is lumbar fixation hardware which is not fully evaluated and degenerative changes at the thoracolumbar junction as previously seen .
    OUTPUT:
    
Cardiomegaly with moderate pulmonary edema .