Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size is normal . Mediastinal contours are unchanged . Hilar contours are within normal limits . Pulmonary vasculature is not engorged . Severe emphysema and lung hyperinflation are re - demonstrated . Again demonstrated about a fiducial marker within the right upper . No additional new focal consolidation , pleural effusion or pneumothorax is present . Multiple remote left - sided rib fractures are again noted .
    OUTPUT:
    
Severe emphysema . Right upper lobe focal opacity about a fiducial marker appears unchanged from the prior chest radiograph and may reflect an area of ongoing infection . Continued followup radiographs after completion of treatment is recommended to ensure resolution of this finding .