FINDINGS:
Patient is status post median sternotomy and cardiac valve replacement.  Dual
 lead left-sided pacer device is seen with leads extending the expected
 positions of the right atrium and right ventricle.  There may very slight
 blunting of the left costophrenic angle posteriorly, seen on the lateral view.
 No right pleural effusion is seen.  There is no evidence of pneumothorax. 
 Biapical, pleural thickening is seen.  The cardiac and mediastinal silhouettes
 are unremarkable.  Mild central pulmonary vascular engorgement is seen without
 overt pulmonary edema.

IMPRESSION:
Very slight blunting of the posterior left costophrenic angle could be due to
 a trace pleural effusion.  Mild central pulmonary vascular engorgement without
 overt pulmonary edema.
 
 No focal consolidation to suggest pneumonia.