FINDINGS:
Again seen is the bilateral small pleural effusions and left base atelectasis.
 Cardiac silhouette is unchanged.  There is no pneumothorax.   Again noted is
 the median sternotomy wires, valve replacements, and Dobhoff tube in expected
 positions.  Changes in the right proximal humerus consistent with previous
 fracture better seen on shoulder radiographs from .

IMPRESSION:
No significant change in appearance of small bilateral pleural effusions and
 left base atelectasis since .