FINDINGS:
Again seen is a right IJ Swan-Ganz catheter, with tip overlying the right
 pulmonary artery.  I doubt significant interval change in position.  Slight
 differences in relation to the vertical portion of the catheter in the IVC,
 compared to the prior film, may be accounted for by differences in the patient
 positioning.  However, when compared to the film from , the tip of
 the Swan- catheter is more distal.    No pneumothorax is detected
 
 Again seen is a left-sided pacemaker/ defibrillator device with lead tips over
 the right atrium and right ventricle and with additional lead unchanged.
 
 There is marked cardiomegaly, similar to the prior film.  There is upper zone
 redistribution.  Possible mild interval increase in degree of pulmonary
 vascular plethora.  No focal consolidation or gross effusion is identified.

IMPRESSION:
1. Doubt significant interval change in position of Swan-Ganz catheter, with
 tip overlying the right pulmonary artery.
 2. Cardiomegaly, unchanged.
 3. Suspect mild CHF.