Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Severe emphysema is again noted . A metallic fiducial marker in the right upper lobe from prior biopsy is present . There is no pneumothorax , pleural effusion , pulmonary edema , or consolidation . Known bilateral upper lobe nodules are better characterized on concurrently obtained CT . A cardiomediastinal silhouette is unremarkable .
    OUTPUT:
    
Severe emphysema . No evidence of pneumonia .