IMPRESSION:
Heart size is normal.  Mediastinum is normal.  Lungs are essentially clear. 
 There is minimal amount of pleural effusion better appreciated on the lateral
 view, new as compared to previous examination.  No appreciable consolidations
 or other findings to explain cough and dyspnea demonstrated.
 
 Of note is that the cardiac silhouette appears to be slightly increased as
 compared to , does either interval development of cardiac
 enlargement or pericardial effusion is a possibility and does correlation with
 echocardiography is recommended.