Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: No pneumothorax . Bilateral pleural effusions are moderate - to - large . The heart is enlarged . There is pulmonary vascular congestion and mild edema . Median sternotomy wires appear intact . No focal consolidation . No evidence of fracture on this single frontal view with portions of the lower ribs excluded from the image . Degenerative changes in the shoulder are moderate to severe .
    OUTPUT:
    
1 . Findings consistent with volume overload / heart failure . 2 . No pneumothorax . 3 . If there is clinical concern of rib fracture , dedicated rib films are recommended .