Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lungs are hyperinflated with prominent retrosternal clear space and upper lung lucency suggesting COPD / emphysema . There is a convex right paramediastinal opacity abutting the right upper lung right for which CT is recommended to further assess . Otherwise lungs appear clear . No large effusion or pneumothorax . Heart is top - normal in size . No signs of congestion or pulmonary edema . Imaged bony structures are intact . No free air below the right hemidiaphragm .
    OUTPUT:
    
1 . Subtle right paramediastinal opacity for which CT chest is recommended to further assess . 2 . Emphysema with top - normal heart size .