IMPRESSION:
In comparison with the study of , the monitoring and support devices
 are essentially unchanged.  Continued enlargement of the cardiac silhouette
 with elevation of pulmonary venous pressure superimposed on diffuse prominence
 of interstitial markings consistent with fibrotic pulmonary disease.  In the
 appropriate clinical setting, would be extremely difficult to exclude
 superimposed pneumonia, especially in the absence of a lateral view.