Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: As compared to ___ , the lungs remain markedly hyperinflated , consistent with COPD . Cardiomediastinal contours are stable in appearance . No new foci of consolidation are evident to suggest pneumonia . Bilateral extrapleural masses are new , including a 4 .5 cm lesion with associated apparent partial destruction of the right ___ posterior lateral rib and a 3 .5 cm pleural or extrapleural lesion adjacent to the seventh left posterior rib with associated slight rib deformity at this level . Thoracic compression deformities and diffuse osseous demineralization are unchanged .
    OUTPUT:
    
1 . No evidence of CHF . 2 . Bilateral extrapleural lesions with associated rib deformities concerning for multiple myeloma or multifocal metastatic disease . Chest CT is recommended for initial further evaluation .