Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Less penetrated film compared with the prior study . Again seen is the tip of the ET tube above the level of the clavicular heads , similar in position . Also again seen is an NG tube that extends beneath the diaphragm off the film , a right IJ central line tip overlying the right atrium , and a right - sided chest tube overlying the right upper zone . No pneumothorax is detected . The cardiomediastinal silhouette is grossly unchanged , with note again made of prominent enlargement of the mediastinum . There is marked upper zone redistribution , more pronounced than on the prior film . With increased vascular plethora and vascular blurring . Hazy opacity in the right cardiophrenic angle probably represents combination of a small amount of pleural fluid in atelectasis . Inspiratory volumes are again noted to be low . Known bilateral rib fractures are incompletely visualized . The tip of the suprarenal IVC filter is noted .
    OUTPUT:
    
Increased upper zone redistribution , vascular plethora and blurring , consistent with increased CHF . Otherwise , the overall appearance is similar . Cardiomediastinal enlargement again noted . No pneumothorax detected .