Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi supine chest radiograph ___ at 03 :59 is submitted .
    OUTPUT:
    
Right internal jugular and subclavian central lines are unchanged in position . Endotracheal tube has its tip at the thoracic inlet . There is a nasogastric tube visualized down to the level of the mid esophagus but due to technique it can not be seen distally . The patient is markedly rotated limiting evaluation of the cardiac and mediastinal contours in this patient status post median sternotomy with aortic valve replacement . There is improved aeration in the right lung but worsening aeration of the left lung suggesting asymmetric fluctuating pulmonary edema . It is difficult to exclude a superimposed infectious process . There may be small layering effusions . No pneumothorax .