FINDINGS:
Frontal and lateral views of the chest.  Slightly lower lung
 volumes are seen on the current exam.  Increased interstitial markings have
 progressed since prior.  There are small bilateral effusions.  Moderate
 cardiomegaly is similar in degree.  Posterior lumbar fixation hardware is
 partially visualized.  No acute osseous abnormality is identified.

IMPRESSION:
Moderate-to-severe enlargement of the cardiac silhouette as on
 prior, with pulmonary vascular congestion and small effusions.