Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is status post sternotomy . The heart is mildly enlarged with a left ventricular configuration . The mediastinal and hilar contours appear unchanged . There is again either a large hiatal hernia with an air - fluid level projecting over the lower chest to the left of midline . There is a mild background interstitial abnormality with indistinct vasculature suggestive of pulmonary congestion . However , new patchy opacities in the right upper and the lower lobes are relatively focal in distribution , in addition to persistent left basilar and lingular opacities . Anterior flowing syndesmophytes are again noted along the thoracic spine . The bones may be demineralized to some degree .
    OUTPUT:
    
Worsening multifocal pulmonary process . Some features suggest multifocal pneumonia , others vascular congestion . Correlation with clinical factors is recommended . Both may be present in this patient or alternatively an unusual pattern of asymmetric pulmonary edema of diffuse pneumonia could be considered as the primary etiology .