Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiomediastinal and hilar contours are stable and within normal limits . The heart is normal in size . The lungs are hyper expanded consistent with emphysema , similar to the prior exam . Calcifications project over the right upper lobe as before . Again seen is asymmetric right apical pleural thickening , with crowding of vessels in scarring in the right upper zone retraction of the right hilum . Clips are seen over the right axilla , unchanged in appearance from the prior study . Bilateral perihilar and bibasilar opacities raise the question of mild CHF , minimally increased from the prior examination . No focal consolidation is identified . No pneumothorax is seen . There is mild blunting of the posterior costophrenic angles bilaterally .
    OUTPUT:
    
COPD , with extensive background parenchymal scarring , right apical pleural thickening , right apical scarring and calcification , and right hilar retraction , again seen . Please note that small pulmonary nodules can be radiographically occult . Perihilar and bibasilar reticular opacities , minimally more pronounced than on the prior study from ___ raise the question of mild superimposed CHF . Atypical infection could also be considered in the appropriate clinical setting .