Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Severe enlargement of the cardiac silhouette is again demonstrated , not substantially changed in the interval . The mediastinal and hilar contours are similar . There is mild pulmonary vascular congestion without edema , unchanged . Mild blunting of the costophrenic angles posteriorly suggests trace bilateral pleural effusions , also not substantially changed in the interval . There is no pneumothorax . No focal consolidation is demonstrated . Mild multilevel degenerative changes are noted in the thoracic spine .
    OUTPUT:
    
Severe cardiomegaly with mild pulmonary vascular congestion and small bilateral pleural effusions , not substantially changed in the interval .