IMPRESSION:
Compared to prior chest radiograph and chest CT on  which showed
 generally clear lungs and severe central adenopathy and a large goiter.
 
 Some pulmonary vascular congestion are new peribronchial opacification has
 developed in the right lower lobe and should be followed for potential early
 pneumonia
 
 Severe cardiomegaly is stable.  Mediastinum is widened by adenopathy.  There
 is no appreciable pleural effusion or pneumothorax.  Left rib fractures noted.