Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Single AP upright portable view of the chest was obtained . The patient is status post median sternotomy . The cardiac silhouette remains moderate - to - severely enlarged . The aorta is calcified . There is mild pulmonary vascular congestion . Hazy opacity projecting over the left costophrenic angle may relate to overlying soft tissue , although a pleural effusion can not be excluded . Small right pleural effusion is also difficult to exclude .
    OUTPUT:
    
Persistent moderate - to - severe enlargement of the cardiac silhouette . Difficult to exclude small bilateral pleural effusions . Pulmonary vascular congestion .