Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Widened mediastinum , tortuous aorta , valve replacement and cardiomegaly are stable . There is no pulmonary edema . Bilateral effusions are small . The sternal wires are aligned . There is no pneumothorax . There are moderate degenerative changes in the thoracic spine
    OUTPUT:
    
No overt pulmonary edema . Increase in size of small right effusion . Small left effusion is grossly unchanged