IMPRESSION:
COMPARED TO CHEST RADIOGRAPH  IN CHEST CTA .
 
 New right internal jugular line ends in the right atrium.
 
 Widespread infiltrative pulmonary abnormality has developed since both prior
 examinations, most recently 13:40 on .  Pulmonary edema is the most
 likely abnormality because of the rapid change, but there are other
 possibilities, including hemorrhage and even severe infection.  Heart size is
 normal.
 
 There is no pneumothorax mediastinal widening or appreciable pleural effusion.
 
 Indwelling transvenous right atrial right ventricular pacer leads are
 continuous from the left pectoral generator.