IMPRESSION:
In comparison with the study of , there is little overall change. 
 Monitoring and support devices are stable.  Continued enlargement of the
 cardiac silhouette with elevation of pulmonary venous pressure in a patient
 with diffuse prominence of interstitial markings consistent with fibrotic
 pulmonary disease.  In the appropriate clinical setting, it would be extremely
 difficult to definitely exclude superimposed pneumonia, especially in the
 absence of a lateral view.