FINDINGS:
Frontal and lateral views of the chest were compared to previous
 exam from  and CT from .  
 
 The lungs are clear, were not obscured by overlying cardiac pacing device. 
 There is blunting of the left posterior costophrenic angle compatible with
 Bochdalek hernia identified on prior CT.  Cardiac silhouette is enlarged but
 stable.  Dual-lead pacing device lead tips again seen in the right ventricular
 apex and right atrium.  Degenerative changes noted at the right glenohumeral
 and acromioclavicular joints.  Mild compression deformity again seen in the
 lower thoracic vertebral body.

IMPRESSION:
Cardiomegaly.  No definite acute cardiopulmonary process or
 evidence of failure.