FINDINGS:
A dual-lead pacemaker/ICD device appears unchanged, again with
 leads terminating in the right atrium and ventricle, respectively.  The heart
 is moderately enlarged with a prominent main pulmonary artery contour. 
 Central pulmonary arterial branches appear enlarged.  The chest is
 hyperinflated.  Mild background coarsening of lung markings is quite similar
 to the remote prior study, although there is mild new reticulation in the
 peripheral parts of lung zones at the bases, suggesting a mild coinciding
 interstitial abnormality.  A bulla is more prominent at the right base. 
 Patchy left basilar opacity suggests minor unchanged atelectasis.  There is no
 definite pleural effusion or pneumothorax.  The bones are probably
 demineralized.

IMPRESSION:
Findings suggest obstructive pulmonary disease with mild
 superimposed interstitial abnormality, suggesting mild superimposed vascular
 congestion.