Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: In comparison to prior study , ill - defined opacities are again seen projecting over the right upper lobe and left upper lobe laterally . The lung bases remain clear . The lungs are hyperexpanded , with flattening of the hemidiaphragms suggesting underlying COPD . There is no effusion . There is no pneumothorax . Hilar and cardiomediastinal contours are normal . There is no pulmonary vascular congestion or edema . Degenerative changes are seen in the thoracic spine .
    OUTPUT:
    
Little change in ill - defined bilateral upper lobe opacities compared to one day prior . The chronicity of these remains indeterminate . Early pneumonia could be considered in the proper clinical setting , though this could represent chronic scarring . Comparison with more remote imaging is recommended . Hyperinflation compatible with known COPD .