FINDINGS:
The patient is rotated somewhat to the left.  The cardiac silhouette remains
 mild to moderately enlarged.  There is slight increase in central pulmonary
 vascular prominence suggesting mild pulmonary vascular congestion.  There may
 be slight prominence of the main pulmonary artery which can be seen with
 underlying pulmonary hypertension.  No pneumothorax is seen.  The lungs remain
 relatively hyperinflated, consistent with COPD.  No discrete focal
 consolidation is seen to suggest lobar pneumonia.  There is slight blunting of
 the costophrenic angles, also present on the prior study, without large
 pleural effusion seen.

IMPRESSION:
Mild pulmonary vascular congestion and mild to moderate cardiomegaly. 
 Persistent blunting of the costophrenic angles without large pleural effusion
 seen.
 
 No discrete focal consolidation to suggest lobar pneumonia.