Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: ET and oro gastric tubes and left - sided pacemaker again noted , similar to the prior study . Allowing for differences in positioning and lower inspiratory volumes , the cardiomediastinal silhouette is grossly unchanged . Prominence of the right hilum again noted , similar to prior . Again seen is vascular plethora and blurring , consistent with CHF grossly similar to prior . Also again seen is increased retrocardiac density consistent with left lower lobe collapse and / or consolidation . Small bilateral effusions again noted . As before , there is a band of somewhat more confluent opacity the junction of the right mid and lower zones .
    OUTPUT:
    
Cardiomegaly , CHF , small bilateral effusions , and left lower lobe collapse and / or consolidation . Overall , the appearance is similar to the prior study . Prominence of the right hilum again noted .