FINDINGS:
PA and lateral views of the chest provided.   Tripolar AICD is unchanged. 
 Midline sternotomy wires is and mediastinal clips are again noted. The heart
 remains moderately enlarged.  The mediastinal contour is stable.  There is a
 small right pleural effusion which is new in the interval.  The lungs appear
 clear without focal consolidation or edema.  No pneumothorax.  Bony structures
 are intact.

IMPRESSION:
Stable cardiomegaly.  New small right pleural effusion.