FINDINGS:
Slightly lordotic positioning.
 
 Cardiomediastinal silhouette is enlarged, but grossly unchanged.  Mild
 prominence of the pulmonary arteries is similar to the prior study.
 
 There is upper zone redistribution, without overt CHF.
 
 There is a small to moderate size left pleural effusion, with underlying left
 lower lobe collapse and/or consolidation.  The effusion appears larger and the
 consolidation more dense than on the prior study.
 
 Again seen is patchy opacity in the right cardiophrenic angle, essentially
 unchanged -- differential diagnosis includes infection versus aspiration or
 early infiltrate.  A small right effusion appears new.

IMPRESSION:
Upper zone redistribution, without overt CHF, similar to the prior study.
 Cardiomegaly, unchanged.
 
 Small to moderate left effusion and left lower lobe collapse and/or
 consolidation have increased.
 
 Patchy opacity in the right cardiophrenic region is is unchanged.  Small right
 effusion appears new.