Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP portable upright view of the chest . Cardiomegaly is unchanged with significant enlargement of the main pulmonary artery , unchanged . There is increased opacity in the left lung base consistent with moderate pleural effusion and atelectasis , can not exclude pneumonia . A small right pleural effusion is also present . Upper lung lucency is suggestive of emphysema . A nodular opacity projects over the right upper lung which appear stable from multiple prior exams . No pneumothorax . A right proximal humeral hardware is partially imaged . Widening of the left AC joint with elevated left distal clavicle is unchanged compatible with an old grade 3 AC joint separation .
    OUTPUT:
    
1 . Bilateral pleural effusions with left basal atelectasis , can not exclude pneumonia . 2 . Probable underlying emphysema . 3 . Additional chronic changes as described above .