FINDINGS:
Compared with the prior study, mild cardiomegaly is new, with new
 indistinctness of the pulmonary vasculature and cephalization, indicating
 early congestive heart failure.  Small region of bullae in the right upper
 lobe indicates underlying emphysema.  No focal consolidation or large
 effusions.  No pneumothorax.

IMPRESSION:
1.  Findings suggestive of early congestive heart failure.
 
 2.  Right upper lobe emphysema.