FINDINGS:
The patient is status post median sternotomy.  Dual-lead left-sided
 AICD is again seen with leads extending to the expected positions of the right
 atrium and right ventricle, similar in position.  The cardiac silhouette
 remains enlarged.  The mediastinal contours are stable.  No pleural effusion
 or evidence of pneumothorax is seen.   There is moderate pulmonary vascular
 congestion.  No definite focal consolidation.  There is some
 thickening/possible fluid along the minor fissure seen on the lateral view.

IMPRESSION:
Enlarged cardiac silhouette and moderate pulmonary vascular
 congestion.