Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperinflated with emphysematous changes most pronounced in the lung apices . The cardiac , mediastinal and hilar contours are unchanged , with the heart size appearing mildly enlarged . Enlargement of pulmonary arteries is re - demonstrated , compatible with underlying pulmonary arterial hypertension . No pulmonary edema is demonstrated . Bibasilar airspace opacities have progressed compared to the previous radiograph . No pleural effusion or pneumothorax is identified . Posterior thoracic fusion hardware is re - demonstrated along with multiple surgical ___ along the midline .
    OUTPUT:
    
Worsening bibasilar airspace opacities may reflect worsening atelectasis or infection , with aspiration not excluded . Emphysema . Enlargement of pulmonary arteries compatible with pulmonary arterial hypertension .