FINDINGS:
There is engorgement of the central pulmonary vasculature,
 cephalized flow and indistinctness of the pulmonary vessels, all compatible
 with interstitial edema.  Mild aortic tortuosity is again noted with calcified
 plaque seen at the arch.  This is stable compared to prior exams.  Similarly,
 the cardiac silhouette is borderline enlarged and again stable.  There is a
 small right pleural effusion.  No left effusion is noted.  There is no
 pneumothorax.  The osseous structures reveal mild multilevel degenerative
 disease in the mid thoracic spine.

IMPRESSION:
Interstitial edema, likely cardiogenic in etiology.  Recommend
 repeat radiography after appropriate diuresis to assess for underlying
 infection.