Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are clear of focal consolidation , effusion , or overt pulmonary edema . Cardiac silhouette is enlarged similar configuration compared to prior . Tortuosity of the descending thoracic aorta is again noted . No acute osseous abnormalities identified . Degenerative changes again seen at the right shoulder .
    OUTPUT:
    
Cardiomegaly without acute cardiopulmonary process .