Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The overall appearance is unchanged since ___ . The heart is mildly enlarged . The lungs remain hyperinflated . Old rib fractures are unchanged . Coarse interstitial opacities are again seen , denoting a chronic process . There is no large effusion , and no pneumothorax .
    OUTPUT:
    
Examination unchanged since ___ . No superimposed acute process seen .