Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Cardiac , mediastinal and hilar contours are unchanged with the heart size within normal limits . Prominence of the hila bilaterally reflects borderline enlarged pulmonary arteries . Lungs are hyperinflated with severe emphysematous changes again noted . Scarring within the lung apices is more pronounced on the right . No pulmonary edema is demonstrated . No focal consolidation , pleural effusion or pneumothorax is noted . Previously seen pulmonary nodules on CT are not as well visualized on the current exam . 5 cm rounded opacity projecting over the left mid lung field is compatible with known osseous metastasis of the left fourth rib .
    OUTPUT:
    
Known pulmonary and osseous metastases are better assessed on the prior CT . No focal consolidation to suggest pneumonia . Severe emphysema .