FINDINGS:
Midline sternotomy wires and mediastinal clips are again noted.  There is new
 consolidation within the left lower lobe which is concerning for pneumonia.  A
 small left pleural effusion is also likely present.  Calcified granulomas
 project over the right upper lung.  Otherwise right lung is clear. 
 Cardiomediastinal silhouette is unchanged.  Bony structures are intact.

IMPRESSION:
Interval development of pneumonia in the left lower lobe.  Small left pleural
 effusion.