Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable AP upright chest film ___ at 16 :36 is submitted .
    OUTPUT:
    
There has been interval appearance of bilateral but asymmetric , right greater than left , airspace process which may represent asymmetric moderate to severe pulmonary edema although diffuse pneumonia and pulmonary hemorrhage could also have this appearance . Clinical correlation is advised . A single lead left - sided pacer remains in place . There has been interval intubation with the endotracheal tube having its tip approximately 6 cm above the carina . A nasogastric tube is seen coursing below the diaphragm with the tip not identified . The heart remains enlarged which most likely reflects cardiomegaly . Mediastinal contours are difficult to assess due to the diffuse airspace process . There is likely a small left effusion . No large pneumothorax is appreciated .