FINDINGS:
A dual-lead pacemaker/ICD device appears unchanged, with the leads
 again terminating in the right atrium and ventricle, respectively.  The
 patient is status post median sternotomy.  New mild right lateral pleural
 thickening suggests a small effusion with loculation.  A more free flowing
 pleural effusion of small-to-moderate size is suspected on the left with
 thickening of the fissures.  Streaky atelectasis is also seen within the
 lingula.  There is no evidence for parenchymal edema.  Thin anterior flowing
 osteophytes suggest skeletal hyperostosis.  Mild degenerative changes are also
 present.  The bones are probably demineralized to some extent.

IMPRESSION:
New left-sided pleural effusion; and small, probably loculated
 pleural effusion on the right, which may be due to sequelae of a more remote
 prior effusion.