Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is enlarged . The hila are again very enlarged bilaterally . There is superimposed central vascular congestion with moderate pulmonary edema . Bilateral pleural effusions are again seen , worse on the right . There is no pneumothorax . The right lung apex is obscured by an overlying object .
    OUTPUT:
    
Cardiomegaly with superimposed moderate pulmonary edema and a right pleural effusion , unchanged since ___ . Persistant hilar prominence may reflect underlying pulmonary arterial hypertension .