FINDINGS:
The lung volumes are decreased compared to the prior study from
 , with elevation of the minor fissure, which contains either a
 small amount of fluid or is thickened.  There are moderate bilateral pleural
 effusions, difficult to quantify but likely increased, although decreased lung
 volumes are a confounding factor in evaluating for change.  Bibasilar
 associated parenchymal opacities could represent compressive atelectasis,
 although concomitant infection in either lung base is not excluded.  There is
 pulmonary vascular congestion without frank interstitial edema.  The heart
 size is difficult to assess but appears moderately enlarged.  The mediastinal
 contours are unchanged, with widening of the mediastinum attributable to known
 dilatation of the thoracic aorta.  Midline sternotomy wires are intact. 
 Scattered mediastinal clips are again seen.  Multilevel degenerative changes
 of the thoracolumbar spine are noted.

IMPRESSION:
1.  Low lung volumes with persistent moderate bilateral pleural effusions,
 probably increased somewhat but difficult to quantify.  Pleural effusions
 could be better assessed with decubitus views if needed clinically.
 
 2.  Bibasilar lower lung opacities, possibly secondary to compressive
 atelectasis, although concomitant infection in either lung base is not
 excluded.