FINDINGS:
Frontal and lateral views of the chest are obtained.  There is a
 dual-lead left-sided pacemaker with leads extending to the expected positions
 of the right atrium and right ventricle.  There is marked elevation of the
 right hemidiaphragm and a subpulmonic effusion is not excluded.  The left lung
 is clear.  No focal consolidation is seen.  The cardiac silhouette is mildly
 enlarged.  The aortic knob is calcified.

IMPRESSION:
Marked elevation of the right hemidiaphragm, new since ,
 subpulmonic effusion not excluded.