Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size is normal . Mediastinal and hilar contours are within normal limits and unchanged . The aortic knob is calcified . There are emphysematous changes again noted , severe in extent . 8 mm nodular opacity projecting over the left lung apex is new compared to the prior study , but could reflect the end of the left 1st rib or a summation of shadows . No focal consolidation , pleural effusion or pneumothorax is present . Blunting of the costophrenic angle on the left posteriorly likely is due to chronic pleural thickening . No acute osseous abnormalities are present . Cholecystectomy clips are seen in the right upper quadrant the abdomen .
    OUTPUT:
    
1 . Severe emphysema without acute abnormality . 2 . 8 mm nodular opacity within the left lung apex . Shallow oblique views are recommended to assess if this is a true nodule versus a summation of shadows or rib end .