Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Cardiac silhouette is mildly enlarged and has minimally increased in size since the previous study . Additionally , there has been slight increase in caliber of the pulmonary vessels which appear indistinct and are accompanied by peribronchial cuffing and a bilateral interstitial pattern with a basilar predominance . Upper lobe predominant emphysema is again demonstrated as well as an area of linear scarring in the left upper lobe . In addition to bilateral interstitial opacities , heterogeneous , more confluent areas of opacity have developed at the bases , greater than right . No definite pleural effusion , but there is slight thickening of the fissures bilaterally .
    OUTPUT:
    
New radiographic findings which could reflect an asymmetrical pattern of congestive heart failure superimposed upon chronic emphysema . Coexisting pneumonia should be considered , especially particularly in the left lower lobe . Followup chest radiograph after diuresis may be helpful for initial further evaluation .