FINDINGS:
Comparison is made to prior study from .  
 
 There is cardiomegaly.  Tracheostomy is again seen.  There is elevation of the
 right hemidiaphragmatic contour.  There is prominence of the pulmonary
 vascular markings.  There is again seen a prominent mediastinum; however, this
 is consistent with known heterogeneous substernal goiter as seen on the prior
 chest CT.  There is a vascular catheter seen in the axilla on the right side.