FINDINGS:
Dual-lead left-sided pacemaker terminates with leads in the proper
 position.  Chain sutures along the right lung base are again noted and appear
 stable.
 
 Again visualized is a loculated small left pleural effusion as well as a small
 right pleural effusion, appearing stable in comparison to prior study.  There
 is a new confluent patchy opacity in left lower lobe in comparison to the
 prior study, which may be representative of developing pneumonia.  Otherwise,
 the remainder of the lungs is clear.  The cardiomediastinal silhouette remains
 stable.  The visualized osseous structures are stable.

IMPRESSION:
1.  Stable small loculated left and small right pleural effusions.
 2.  Heterogeneous opacity in the left lower lobe may be representative of
 developing pneumonia in the appropriate clinical setting.