Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Massive cardiomegaly is demonstrated , not substantially changed from the prior study . The aorta remains tortuous . Lungs are hyperinflated with unchanged moderate paraseptal and centrilobular emphysema again noted . Mild interstitial pulmonary edema is worse in the interval . Pulmonary arteries remain enlarged suggestive of underlying pulmonary arterial hypertension . No focal consolidation , pleural effusion or pneumothorax is clearly evident .
    OUTPUT:
    
Mild interstitial pulmonary edema , worse in the interval , superimposed on a background of moderate emphysema . Severe cardiomegaly and evidence of pulmonary arterial hypertension .