IMPRESSION:
Severe enlargement of the cardiomediastinal silhouette has been stable for
 several days.  There is no pneumothorax or appreciable right pleural effusion.
 The volumes of pleural fluid and atelectasis at the base the left lung are
 indeterminate, obscured by the cardiac silhouette.  Pulmonary vasculature is
 minimally more engorged today but there is no pulmonary edema.
 Left internal jugular line and a right PIC line are unchanged in standard
 placements. Transvenous biventricular pacer leads also in stable position.