Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Extensive confluent interstitial fibrotic changes are again noted , in a similar distribution compared to prior exams , with peripheral basilar predominance . No new opacification is identified . The cardiomediastinal silhouette is unchanged compared to the prior radiograph , with stable moderate cardiomegaly and calcifications in the aortic arch . There is no pleural effusion or pneumothorax . Surgical clips are noted in the upper abdomen .
    OUTPUT:
    
1 . Extensive chronic pulmonary fibrotic changes are again noted in a similar distribution . 2 . Underlying edema or infection is difficult to exclude . 3 . Moderate cardiomegaly is stable .