FINDINGS:
Frontal and lateral views of the chest are obtained.  Dual lead of
 left-sided pacemaker is again seen with leads extending to the expected
 positions of the right atrium and right ventricle, unchanged.  Patient is
 status post median sternotomy and aortic valve replacement, grossly stable. 
 Again seen is blunting of the left costophrenic angle suggesting pleural
 effusion with overlying atelectasis.  Underlying consolidation cannot be
 excluded.  There is slight increase in opacity at the right lung base which
 may be due to atelectasis, although the appropriate clinical setting, early
 aspiration or pneumonia are not excluded.  Surgical clips are again seen
 projecting over the lateral right upper hemithorax.