Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest were obtained . The lungs are hyperinflated , with flattening of the diaphragms , consistent with chronic obstructive pulmonary disease and pulmonary emphysema . There is a a spiculated opacity projecting over the medial right upper hemithorax , which was not clearly seen on the prior study . Minimal bilateral upper lobe pulmonary parenchymal scarring is again seen . No pleural effusion or pneumothorax is seen . The aorta is calcified and tortuous . The cardiac silhouette is not enlarged .
    OUTPUT:
    
1 . Spiculated opacity projecting over the medial right upper lobe for which further evaluation with chest CT is recommended . 2 . Pulmonary emphysema .