Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperinflated with marked emphysematous changes again demonstrated , most pronounced at the lung apices . Increased interstitial markings are noted diffusely bilaterally , likely representing chronic changes with mild superimposed interstitial edema . The heart size remains mildly enlarged . The aorta is calcified . Small bilateral pleural effusions are present . There is no pneumothorax or focal consolidation . Multiple clips are demonstrated overlying the posterior spine .
    OUTPUT:
    
Severe emphysema with increased interstitial markings bilaterally suggestive of mild interstitial edema superimposed on chronic changes . Small bilateral pleural effusions .