FINDINGS:
There is moderate cardiomegaly.  The small left pleural effusion is
 unchanged compared to the prior exam.  There appears to be mild interstitial
 edema. No new focal consolidations are identified. There is no pneumothorax. 
 The transvenous right atrial and left ventricular pacer leads and right
 ventricular pacer defibrillator leads are unchanged in position compared to
 the prior exam.

IMPRESSION:
No acute abnormalities identified to explain patients abnormal left base
 breath sounds.