FINDINGS:
PA and lateral views of the chest were obtained.  Midline
 sternotomy wires and mediastinal clips are again noted. There is a background
 of emphysema better appreciated on the prior radiographs. There has been
 interval development of pulmonary vascular congestion and mild pulmonary
 edema.  Trace bilateral pleural effusions are present.  No pneumothorax. 
 Cardiomediastinal silhouette is stable.  Bony structures are intact.

IMPRESSION:
Emphysema with superimposed pulmonary edema.  Trace bilateral
 pleural effusions.