FINDINGS:
The heart is normal in size.  The mediastinal and hilar contours appear within
 normal limits.  There is no pleural effusion or pneumothorax. There is a small
 calcified granuloma in the left lower lobe, as before; otherwise the lungs
 appear clear.  A mixed lytic and sclerotic bone lesion along the left anterior
 lateral fourth rib appears unchanged allowing for differences in technique and
 accordingly suggests a benign finding.

IMPRESSION:
No evidence of acute cardiopulmonary disease.  Stable rib lesion.