a dual lead left-sided pacer is in place with the leads terminating over the expected location of the right atrium and right ventricle, respectively. the heart is mildly enlarged which most likely reflects cardiomegaly, although pericardial effusion cannot be excluded. the lungs are hyperinflated suggesting underlying emphysema. blunting of both posterior costophrenic angles likely reflects small effusions. no evidence of pulmonary edema. no pneumothorax.