FINDINGS:
There are bilateral lower lobe predominant interstitial opacities
 with vascular cephalization and mediastinal and hilar engorgement.  Bilateral
 pleural effusions, left worse than right are present. Streaky retrocardiac
 opacities likely represent atelectasis.  There is significant cardiac
 enlargement compared with prior exam.  Atherosclerotic calcifications of the
 aortic knob are present.  Sternotomy wires, mediastinal clips, and prosthetic
 aortic valve are redemonstrated and intact.

IMPRESSION:
1.  Acute pulmonary edema with associated bilateral pleural effusions.  
 2.  Significant new cardiomegaly and/or pericardial effusion.