Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again seen is hyperinflation consistent of background COPD . Cardiomediastinal silhouette is prominent , but unchanged . Also again seen is upper zone redistribution , without overt CHF . At the left base , there is subsegmental atelectasis and / or scarring , but no frank consolidation . There is a small amount of left pleural fluid and / or thickening . The appearance is probably not significantly from earlier the same day , changed allowing for technical differences . No pneumothorax detected . Biapical pleural scarring is is unchanged . Mild thoracic - spine degenerative changes noted . No displaced rib fracture or obvious thoracic compression fracture identified . Appearance of the right IJ central line is unchanged .
    OUTPUT:
    
1 . COPD . 2 . Upper zone redistribution without overt CHF . 3 . Subsegmental atelectasis and / or scarring at the left base and possible small amount of pleural fluid versus thickening , unchanged . 4 . No focal pneumonic infiltrate detected . No pneumothorax . 5 . Right IJ line unchanged in configuration . As noted , the course of the line raises the possibility of an arterial position , but this appearance could also be artifactual due to patient rotation and possible left - sided volume loss . As before , if there is ongoing clinical concern for the course of the central line , then a lateral chest x-ray and / or targeted CT images could help to confirm position .