Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Cardiac silhouette size is normal . The mediastinal contour is within normal limits . Enlargement of both hilar regions is compatible with underlying pulmonary arterial dilatation . Pulmonary vasculature is not engorged . Severe emphysema is present with hyperinflation of the lungs . Small left pleural effusion is unchanged and trace right pleural effusion appear slightly increased in the interval . Nodular opacities within both upper lobes appear grossly unchanged , and better characterized on the recent CT . Patchy right basilar opacity and consolidation in the left lower lobe are not substantially changed in the interval . Pneumothorax is detected . Compression deformity within a mid thoracic vertebral body is unchanged .
    OUTPUT:
    
1 . Persistent opacities in the lung bases concerning for pneumonia or aspiration with continued atelectasis in the left lower lobe . 2 . Small left pleural effusion is unchanged . Trace right pleural effusion is minimally increased . 3 . Nodular opacities in both upper lobes are relatively unchanged and previously characterized on the recent CT . 4 . Severe emphysema with pulmonary arterial hypertension .