Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral chest views were obtained with patient in upright position . Analysis is performed in direct comparison with the next preceding PA and lateral chest examination of ___ . Moderate cardiomegaly as before . Upper mediastinal structures are obscured by the presence of two ___ rods each with 4 penetrating fixation screws stabilizing the mid portion of the thoracic spine . Integrity of orthopedic devices appears preserved and is unchanged . Similar as on the previous examination , there is evidence of bilateral pleural effusion blunting the lateral pleural sinuses . The pleural effusion is moderately more marked on the right side than the left . Lateral view indicates extension of fluid into the posteriorly located dependent pleural sinuses . No evidence of new acute discrete pulmonary infiltrates indicating acute pneumonia . No pneumothorax seen in the apical area .
    OUTPUT:
    
Bilateral small pleural effusions and moderate congestive pulmonary vascular pattern . In comparison with the next previous examination 18 months ago , the patient 's pulmonary congestion and pleural effusions were markedly more pronounced than they are now . Whether the present degree of chronic CHF is related to fluid overload must be judged on clinical grounds .