Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperexpanded with flattening of the hemidiaphragms best appreciated on the lateral views . The lungs are clear . No focal consolidation , pleural effusion , pulmonary edema , or pneumothorax . The cardiomediastinal silhouette is unchanged . A well - defined opacity at the right juxtacardiac angle is overall unchanged in size and may represent herniated omental fat in a Morgagni hernia , pericardial fat , or pericardial cyst . The hila are unremarkable . Old rib fractures are unchanged . Degenerative changes in both shoulders , worse on the left are noted . Multi - level degenerative changes are also noted in the thoracic spine with prominent anterior osteophytes .
    OUTPUT:
    
1 . Chronic obstructive pulmonary disease . 2 . No acute intrathoracic process . 3 . Unchanged appearance of the large abnormality in the right cardiophrenic sulcus since ___ - may be pericardial cyst , mediastinal fat , or Morgagni hernia transmitting subphrenic fat . Correlation with any prior chest CT , as previously recommended , is recommended .