Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: With a right - sided pigtail catheter to water seal , the small right apical pneumothorax has slightly increased in size . Otherwise , no significant change from the prior exam . Severe dextroconvex scoliosis of the thoracic spine with associated distortion of the thoracic cage is stable . The lungs are hyper - expanded , suggestive of chronic emphysema . Diffuse bilateral opacities and prominent interstitial markings are stable and consistent with reported chronic pulmonary fibrosis . Stable cardiomegaly . Left sided pleural thickening , of unclear etiology needs to be evaluated .
    OUTPUT:
    
1 . Slight interval increase in the size of the small right apical pneumothorax after placing the chest tube to water seal . 2 . Left - sided pleural thickening of unclear etiology . Recommend obtaining prior chest radiographs for comparison and obtaining further clinical history , such is possible scarring from a prior left - sided chest tube placement . If the thickening is new , this should be investigated .