FINDINGS:
Again, the overall chest anatomy is distorted by severe levoconvex
 thoracic scoliosis.  Redemonstrated is a left hilar spiculated opacity with
 evidence of retraction of the adjacent parenchyma and left lung volume loss,
 demonstrating slight interval progression compared to the prior exam from
 .  There is a consolidation along the right middle lobe as well as a
 generalized opacity overlying the left mid-to-lower lung.  There may be small
 bilateral pleural effusions.  The cardiomediastinal silhouette is mildly
 shifted leftward.  There is no evidence of a pneumothorax.  The visualized
 osseous structures are unremarkable.

IMPRESSION:
1.  New opacity along the right middle lobe as well as a generalized opacity
 overlying the mid-to-lower left lung raises concern for an infectious process.
 
 2.  Spiculated left hilar opacity with retraction of the adjacent parenchyma
 is again concerning for a malignant process or represent post-treatment
 scarring; however, comparison with outside prior cross sectional studies or a
 new chest CT is recommended for further evaluation.