IMPRESSION:
AP chest compared to :
 
 Two leads of a three-lead right pectoral ICD pacemaker can be traced to the
 standard positions in the right atrium and right ventricle, the third lead,
 intended left ventricular lead, passes into the coronary sinus, but its tip is
 not visible.  Conventional chest radiographs should be able with show it.
 
 There is no pneumothorax or attributable pleural effusion or mediastinal
 widening.  Mild cardiomegaly is chronic.  Hyperinflation indicates COPD. 
 Small left pleural effusion or pleural thickening is unchanged since prior
 studies.