IMPRESSION:
As compared to the previous radiograph, the previously malpositioned PICC line
 in the left jugular vein has been pulled back. However, on today's
 examination, the PICC line appears to project over the right axillary region. 
 The line should be completely withdrawn and repositioned.
 
 The previous right internal jugular vein catheter was removed. There is
 unchanged mild cardiomegaly at lower lung volumes. These low lung volumes are
 essentially caused by an elevation of the right hemidiaphragm, better
 appreciated on the lateral than on the frontal radiograph.  No current
 evidence of larger pleural effusions, pulmonary edema, or pneumonia. Unchanged
 pacemaker leads and left pectoral pacemaker generator.