FINDINGS:
PA and lateral views of the chest are compared to previous exam
 from  and CTA from .
 
 Again seen are bilateral calcified pleural plaques.  There is engorgement of
 the central pulmonary vasculature with mild indistinctness of the vessels. 
 There is a left-sided pleural effusion which is small but slightly larger
 compared to previous exam.  There is no significant right pleural effusion. 
 Increased density projecting over the posterior aspect of the heart on the
 lateral is view at least in part due to calcified pleural plaques seen on
 prior CT of the chest from . Cardiac silhouette is enlarged,
 mildly increased compared to most recent prior.  Dual-lead pacing device is in
 stable position.  Osseous and soft tissue structures are unchanged.

IMPRESSION:
1.  Findings suggestive of mild failure.  Slightly increased left-sided
 pleural effusion and cardiomegaly.
 2.  Bilateral calcified pleural plaques.