Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiac , mediastinal and hilar contours appear unchanged . The heart size is normal in size . Prominence of the right hilum appears unchanged also since the earliest study available and may reflect mild prominence of the pulmonary arteries . Nipple shadows on each side are visualized and appear unchanged . The lungs are markedly hyperinflated and mid to upper lungs appear markedly lucent suggesting severe emphysema . Blunting of each costophrenic sulcus appears chronic and is probably due to scarring , although it is difficult to exclude trace effusions . There is no pneumothorax .
    OUTPUT:
    
Findings consistent with severe emphysema without evidence for superimposed pneumonia or pulmonary edema .