Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperinflated with flattening of the diaphragms consistent with underlying COPD . There is extensive biapical scarring , which appears slightly nodular . There is no focal consolidation concerning for pneumonia , pleural effusion or pneumothorax . The cardiomediastinal silhouette is within normal limits . There is calcification of the aortic knob . No acute osseous abnormalities detected . There is generalized loss of height in the lower thoracic vertebral bodies .
    OUTPUT:
    
1 . No cardiomegaly or pneumonia . 2 . Evidence of COPD and nodular by apical scarring , which warrants comparison to prior imaging or additional characterization with non urgent / outpatient chest CT . Differential includes reactivation tuberculosis , mycetoma , or malignancy .