IMPRESSION:
Moderately severe infiltrative pulmonary abnormality has worsened once again
 since , probably edema.  Moderate cardiomegaly is chronic. There is
 no pneumothorax.  Left pleural effusion is small.
 
 ET tube is in standard placement. Nasogastric tube passes below the diaphragm
 and out of view.  Right jugular line and right PIC line ends at the origin of
 the SVC. Transvenous right ventricular pacer defibrillator lead is continuous
 from the left pectoral generator. .