FINDINGS:
There has been interval enlargement of the cardiac silhouette size which is
 now moderate to severely enlarged.  The configuration of the cardiac
 silhouette is somewhat globular, and a pericardial effusion is not excluded. 
 Aortic calcifications are again demonstrated.  The mediastinal contours are
 unchanged.  There is perihilar haziness and vascular indistinctness which is
 more pronounced compared to the prior study compatible with mild pulmonary
 edema.  More focal patchy opacity within the right lung base is noted and an
 underlying infectious process in this region is not completely excluded.  The
 lungs are hyperinflated with relative lucency of the lung apices compatible
 with emphysema.  No definite pleural effusion is noted.  There is no
 pneumothorax.  Clips are noted in the right upper quadrant the abdomen
 compatible with prior cholecystectomy.

IMPRESSION:
Worsening congestive heart failure, mild to moderate in extent.  Globular
 configuration of the cardiac silhouette raises the possibility of underlying
 pericardial effusion.  More focal opacity in the right lung base likely is
 related to the patient's pulmonary edema, though underlying infection is not
 excluded.