Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP upright and lateral views of the chest provided . Tracheostomy tube projects over the lower neck . A right upper extremity access PICC line terminates in the low SVC . Lung volumes are low with pulmonary fibrosis noted bilaterally as on prior . Difficult to exclude a superimposed pneumonia though overall pattern of pulmonary opacity is unchanged . No large effusion or pneumothorax . Cardiomediastinal silhouette appears unchanged . Bony structures are intact . No free air below the right hemidiaphragm .
    OUTPUT:
    
No significant change from prior . Extensive pulmonary fibrosis . Difficult to exclude a subtle superimposed pneumonia .