FINDINGS:
There has been interval increase in cardiomegaly with increased
 prominence of mediastinal veins and prominence of peripheral interstitium
 consistent with pulmonary edema.  There is a homogeneous opacity seen in the
 left lower lobe concerning for infection.  Seen again is left pectoral implant
 pacer device with leads in unchanged position terminating within the right
 ventricle and atrium.  There is no pleural effusion or pneumothorax.  The
 patient has significant pectus excavatum, otherwise, the osseous structures
 are unremarkable.

IMPRESSION:
1.  Increased cardiomegaly and pulmonary edema consistent with CHF.
 2.  Left lower lobe pneumonia.