Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient 's severe cardiomegaly has been waxing and waning and today is again enlarged . The biggest change since prior radiograph is the substantial increase in pulmonary edema evidence by bilateral diffuse interstitial opacities and hilar engorgement . These findings are not accompanied by any significant pleural effusion . There is no pneumothorax . A biventricular pacemaker battery pack is in unchanged position . One lead leading to the left ventricle is in unchanged position ; the other lead in the is off the view of this film .
    OUTPUT:
    
Cardiomegaly , interstitial opacities and hilar engorgement consistent with cardiogenic pulmonary edema . No significant pleural effusion .