FINDINGS:
Lung volumes are diminished which exaggerates the cardiomediastinal
 configuration.  However, even accounting for this change, there has been a
 relative dramatic increase in the size of the cardiac silhouette with now
 somewhat globular morphology.  Ill-defined opacity is noted in the
 retrocardiac left lower lobe which is likely atelectasis given the volume
 loss.  There is no focal consolidation.  No definite effusion or pneumothorax
 is seen.  The osseous structures are unremarkable.  Incidental note is made of
 internal fixation hardware, incompletely evaluated, involving the mid
 diaphysis of the right clavicle.  Tubing loops over the epigastric region and
 with the tip projecting at the dome of the left hemidiaphragm over the cardiac
 silhouette.

IMPRESSION:
Interval enlargement of the cardiac silhouette even accounting
 for patient and technical factors.  This likely signifies at least an increase
 in the size of the apparently known pericardial effusion.