Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest provided . Midline sternotomy wires and mediastinal clips again seen with a left chest wall AICD with leads extending to the region the right atrium and right ventricle . Overall the appearance of the chest is unchanged with severe pulmonary a edema , small bilateral pleural effusions . No pneumothorax . Bony structures intact . Cardiomediastinal silhouette unchanged .
    OUTPUT:
    
Persistent pulmonary edema with small bilateral pleural effusions .