Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi supine chest radiograph ___ at 08 : 20 is submitted .
    OUTPUT:
    
The patient is markedly rotated limiting evaluation of the cardiac and mediastinal contours . However , the heart does remain enlarged which may reflect cardiomegaly , although pericardial effusion should also be considered . There is worsening pulmonary edema . Bilateral layering effusions . Bilateral rib fractures as previously seen .