FINDINGS:
Frontal and lateral views of the chest.  Dual-lead chest wall pacer
 is seen with leads within the right atrium and right ventricular apex.  Mitral
 valve replacement is again seen.  Blunting of the left lateral costophrenic
 angles likely due to pericardial fat pad.  The lungs are clear without focal
 consolidation, effusion or pneumothorax.  The cardiac silhouette is enlarged
 but stable.  Atherosclerotic calcifications again seen at the aortic arch.  No
 acute osseous abnormality is identified.

IMPRESSION:
Cardiomegaly.  No superimposed acute cardiopulmonary process.