FINDINGS:
As compared to the previous radiograph, the lung volumes are
 unchanged.  Status post left shoulder surgery.  No evidence of pleural
 effusions or pneumothorax.  The size of the cardiac silhouette continues to be
 borderline, without evidence of pulmonary edema.
 
 In the interval, the tortuosity of the thoracic aorta has increased and the
 diameter of the aortic arch and aortic knob also appears increased.  This
 effect could in large parts be due to patient rotation.  However, there also
 is the possibility of an aortic disease at the level of the arch and proximal
 part of the descending aorta.  Therefore, if clinically possible, a CTA of the
 aorta should be performed to rule out acute aortic disease.
 
 At the time of dictation and observation, :52 a.m., the referring physician,
 . , was paged for notification. At 9:40 a.m. on the same day, findings
 were discussed over the telephone with Dr. ,  the recommendation
 for a CTA.