Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is moderately enlarged . There is moderate pulmonary vascular congestion and pulmonary edema . Small bilateral pleural effusions are present . There is no pneumothorax .
    OUTPUT:
    
Moderate cardiomegaly , vascular congestion , pulmonary edema , and pleural effusions consistent with decompensated heart failure . A superimposed pneumonia is difficult to exclude in the appropriate clinical setting .