Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP portable upright view of the chest . Clips in the right axilla noted . Overlying EKG leads are present . There is underlying emphysema with superimposed pulmonary congestion and edema which appears moderate to severe . She underlying pneumonia difficult to exclude . No large effusion is seen . No large pneumothorax . Overall cardiomediastinal silhouette is stable . No acute bony abnormalities . Gas-filled stomach noted .
    OUTPUT:
    
Moderate to severe pulmonary edema superimposed on a background of emphysema . Difficult to exclude a underlying pneumonia .