FINDINGS:
New transvenous   pacemaker  leads follow the expected courses to the right
 atrium and right ventricle.  There is  no pneumothorax, mediastinal widening
 or pleural effusion.  A hazy opacity abutting the cardiac apex is larger
 today. Lungs are otherwise clear. Dilated   main pulmonary artery is bigger,
 but, otherwise the cardiac configuration is normal.

IMPRESSION:
New dual lead pacemaker leads terminating in the right atrium and right
 ventricle.  No complications.
   Possible lesion in the lingula.  Recommend correlation with any other chest
 imaging available to see if a clinically significant, lung lesion can be
 excluded.
 
 RECOMMENDATION(S):  If no other chest radiographs or CT performed since 
 are available, consider Chest CT to distinguish benign mediastinal fat
 collection from lung lesion in the lingula.