Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size is normal . The mediastinal contours are unchanged with diffuse atherosclerotic calcification of the thoracic aorta noted . Hilar contours are similar with enlargement of the pulmonary arteries bilaterally suggestive of underlying pulmonary arterial hypertension . Severe bullous emphysema is seen with large bulla noted most pronounced in the right lung base . Patchy opacity within the left upper lobe is new in the interval which may reflect an area of infection though underlying neoplasm can not be excluded . Patchy opacity in the left lung base may also reflect an additional area of infection or atelectasis . No pleural effusion or pneumothorax is seen . There are no acute osseous abnormalities . Surgical anchor is noted in the right humeral head .
    OUTPUT:
    
1 . Marked bullous emphysema . 2 . Patchy left upper lobe opacity , new in the interval , may reflect infection , however underlying neoplasm can not be excluded . Additional patchy left lower lobe opacity may reflect additional site of infection or atelectasis . Followup radiographs after treatment are recommended , and if the finding in the left upper lobe persists , dedicated chest CT is suggested . 3 . Pulmonary arterial hypertension .