FINDINGS:
There is a substantial moderate cardiomegaly with a globular
 configuration, which appears increased since the prior examination. 
 Indistinct prominent perihilar opacities suggest mild-to-moderate pulmonary
 edema.  There is no definite pleural effusion or pneumothorax.  In addition to
 other opacities, there is an infrahilar opacity on the lateral view that
 appears more prominent and may correspond to obscuring of the right
 cardiophrenic sulcus on this examination.  Incidental note is again made of an
 azygos fissure, which is consistent with a normal variant.  The osseous
 structures are unremarkable.

IMPRESSION:
1.  Moderate cardiomegaly including substantial increase.  Clinical
 correlation is suggested.  True cardiac enlargement is a consideration, but
 the possibility of a pericardial effusion could also be considered clinically.
 
 2.  Mild-to-moderate pulmonary edema.
 
 3.  Focal infrahilar opacity, of uncertain significance.  It may reflect focal
 edema, but a separate process such as developing focal opacity such as
 pneumonia or atelectasis is an additional consideration.  Short-term follow-up
 radiographs are suggested to evaluate further.