FINDINGS:
The heart size is moderately enlarged with worsening pulmonary edema and
 moderate venous engorgement that appears to have progressed.  A large right
 pleural effusion has a decreased fluid component that has been replaced with
 air.  There is a mild rightward mediastinal shift secondary to right lung
 volume loss.  A feeding tube is seen which terminates in the upper stomach.

IMPRESSION:
1. Moderately enlarged heart with worsening pulmonary edema and increased
 moderate venous engorgement.
 2. Large right pleural effusion with decreased fluid and increased air
 components.