FINDINGS:
There has been significant interval worsening of the left sided pleural
 effusion with associated left lower lobe collapse. A right lower lung opacity
 is a combination of a layering effusion and atelectasis. Vascular congestion
 and interstitial edema is also unchanged.  Assessment of cardiac size is
 limited due to technique but there appears to be moderate cardiomegaly. There
 is no pneumothorax. Left-sided PICC line ends in the mid SVC. Severe
 degenerative changes of the right glenohumeral joint are reidentified.

IMPRESSION:
Significant worsening of the left pleural effusion with associated severe left
 lower lobe atelectasis. Vascular congestion and interstitial pulmonary edema
 not significantly worsened from the previous exam.