Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiac size is again enlarged . There is diffusely increased interstitial markings of the lungs particularly at bilateral bases which are consistent with the patient 's chronic interstitial lung disease . Bullous disease is noted in the left lung apice , not significant changed from the prior studies . No new focal consolidations concerning for pneumonia are present . Loss of the right heart border is due the patient 's pectus . There may be a left - sided pleural effusion .
    OUTPUT:
    
Severe chronic changes and emphysema but no evidence of pneumonia .