FINDINGS:
Frontal and lateral views of the chest are compared to previous
 exam from .  Again low lung volumes are seen.  There is blunting
 of the posterior costophrenic angles suggestive of small effusions.  There is
 also bibasilar atelectasis.  Superiorly the lungs are clear without
 significant pulmonary vascular redistribution.  Cardiomediastinal silhouette
 is unchanged.  Median sternotomy wires and mediastinal clips again noted. 
 Surgical clips in the right upper quadrant suggest prior cholecystectomy. 
 Osseous and soft tissue structures are unremarkable.

IMPRESSION:
Low lung volumes.  Probable small bilateral pleural effusions and
 bibasilar atelectasis although a component of infection should be excluded
 clinically.