Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: As compared to ___ radiograph , the lungs remain hyperinflated with extensive lower lung predominant bullae . Right upper lobe bronchiectasis is again demonstrated , but the extent of bronchial wall thickening and peribronchiolar opacification are slightly improved . nonspecific left apical scarring appears similar . Heart size is normal . Tortuous thoracic aorta is likely unchanged considering patient rotation . High - grade compression deformity in the mid thoracic spine is similar to the prior radiograph .
    OUTPUT:
    
1 . Lower low lung predominant bullous emphysema is highly suggestive of alpha 1 antitrypsin deficiency . 2 . Right upper lobe bronchiectasis with associated improving peribronchiolar opacities which may reflect resolving airways infection or aspiration . Alpha 1 antitrypsin deficiency may also be associated with bronchiectasis . If warranted clinically , chest CT could be obtained for more complete assessment of the airways . At that time , the thoracic aorta may also be more fully assessed to help differentiate tortuosity from dilation of the structure .