Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The pacemaker and leads are unchanged in appropriate position . Tortuous aorta with calcified aortic knob is again present . The heart size is also mildly enlarged . Pulmonary vasculature remains prominent . Bibasilar atelectasis also remains . No large pleural effusion is present . No pneumothorax is seen .
    OUTPUT:
    
Perivascular congestion suggesting early failure . No large pleural effusion .