Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Severe cardiomegaly is unchanged . There is tortuosity of the thoracic aorta . The pulmonary arteries remain prominent . Pulmonary vascular congestion is not visualized . Bilateral pleural effusions are unchanged . Previously seen scattered pulmonary nodules including a spiculated nodule in the left upper lobe are better demonstrated on the prior chest CT . Small bilateral pleural effusions are again seen . There is no pneumothorax . Again seen is herniation of the left inferior lung through a left inferolateral chest wall defect , better seen on the prior chest CT . There are no acute osseous abnormalities . Deformity of the left distal clavicle is suggestive of prior trauma .
    OUTPUT:
    
Little interval change compared to the prior study . Severe cardiomegaly with small bilateral pleural effusions . Redemonstration of herniation of the left lung through an inferolateral left chest wall defect . Scattered pulmonary nodules including a spiculated nodule in the left upper lobe are better visualized on prior CT .