Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lines and Tubes : None Lungs : Again visualized is bilateral severe bronchiectases and emphysema with biapical scarring . Persistent , bilateral mid and upper lung zone and right lower lung zone infiltration , unchanged compared to ___ but increased compared to ___ . This may represent superimposed consolidation likely multi focal pneumonia in the right clinical setting . Bilateral mid zone rounded , likely calcified granulomas are unchanged . Pleura : There is no pleural effusion or pneumothorax Mediastinum : There is no cardiomegaly . Mediastinal silhouette is within normal limits . Bony thorax : There is diffuse osteopenia . Cholecystectomy clips project over the right upper quadrant of the abdomen .
    OUTPUT:
    
Severe bilateral emphysema and bronchiectases with new bilateral upper and mid zone as well as right lower zone infiltration that may represent superimposed multifocal pneumonia in the right clinical setting . This appearance is unchanged compared to ___ but new compared to ___ . No pneumothorax or pleural effusion present .