FINDINGS:
Thin left-sided dual-chamber pacemaker device is again noted with leads
 terminating in the right atrium and ventricle. The aorta is mildly tortuous,
 otherwise the hilar and mediastinal contours are unremarkable. Note is made of
 mild pulmonary vascular congestion. No focal consolidations concerning for
 pneumonia are identified. There is no pleural effusion or pneumothorax. Mild
 to moderate degenerative changes are seen involving both acromioclavicular
 joints.

IMPRESSION:
No acute intrathoracic abnormalities identified.