FINDINGS:
Severe cardiomegaly is again noted.  There is pulmonary vascular congestion,
 worse when compared to prior.  There is no significant effusion or focal
 consolidation.  Left chest wall single lead pacing device is new since ,
 with lead tip at the right ventricular apex.  No acute osseous abnormalities.

IMPRESSION:
Severe cardiomegaly and pulmonary vascular congestion.