FINDINGS:
The heart size is at the upper limits of normal; a pacer unit
 projects over the left chest with the lead terminating in the right ventricle.
 Calcified atherosclerotic disease is present at the aortic knob.  Known
 metastatic lesions in bilateral mid lungs are present.  The right hilus is
 more prominent than on prior exams, suggesting progression of metastatic
 disease.  Bibasilar opacities are present.  There is no large pleural effusion
 or pneumothorax.  Severe degenerative changes are present in the right
 glenohumeral joint and a prosthetic humeral head is present on the left.

IMPRESSION:
1.  Pulmonary metastases with increasing prominence of the right hilus,
 possibly representing progressive lymphadenopathy.
 2.  COPD.
 3.  Bibasilar opacities represent either atelectasis or pneumonia.