FINDINGS:
There are increased interstitial markings seen throughout the lungs
 when compared to prior.  Small bilateral effusions are seen as well, right
 greater than left.  Cardiac silhouette is enlarged but stable in
 configuration.  Median sternotomy wires and mediastinal clips are also noted. 
 Degenerative changes are seen at the left shoulder, potentially
 post-traumatic.

IMPRESSION:
Pulmonary vascular congestion and small bilateral effusions.