FINDINGS:
Moderate cardiomegaly has increased in size compared to the most
 recent prior exam, raising concern for worsening cardiomegaly or a pericardial
 effusion.  The hilar and mediastinal contours are normal.  There is no large
 pleural effusion or pneumothorax.  The visualized osseous structures are
 unremarkable.

IMPRESSION:
Interval increase in the size of the heart raises concern for worsening
 cardiomegaly or a pericardial effusion. Recommend echocardiography for further
 evaluation.
 
  findings d/w Dr.  by Dr.  by phone at :___A on the day
 of the exam by phone.