Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest . Slightly lower lung volumes are seen on the current exam . Increased interstitial markings have progressed since prior . There are small bilateral effusions . Moderate cardiomegaly is similar in degree . Posterior lumbar fixation hardware is partially visualized . No acute osseous abnormality is identified .
    OUTPUT:
    
Moderate - to - severe enlargement of the cardiac silhouette as on prior , with pulmonary vascular congestion and small effusions .