FINDINGS:
On today's exam, there is suggestion of background COPD.  There is
 moderate cardiomegaly, with a tortuous aorta.  The left hemidiaphragm is
 slightly elevated.  This appearance is in keeping with the 
 radiograph.  Slight hilar prominence is also similar to the prior study and
 could reflect an element of pulmonary hypertension.  There is upper zone
 redistribution, without overt CHF.  There are patchy opacities at both lung
 bases similar, but slightly more pronounced, than on the  study and  also
 more pronounced on the  CT.

IMPRESSION:
1.  COPD and cardiomegaly with a tortuous aorta and possible pulmonary
 hypertension.
 
 2.  Upper zone redistribution, without other evidence of CHF.
 
 3.  Patchy opacity at both bases. This may very well represent atelectasis or
 scarring, but it is more pronounced than on the  radiograph and the
 differential could include areas of aspiration or infectious infiltrate. 
 Clinical correlation is requested.