Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart size is normal . Mediastinal and hilar contours are within normal limits . Left apical opacification is new compared to the prior exam , and concerning for malignancy . Right - sided apical pleural scarring is demonstrated . The lungs are hyperinflated and bullae are again demonstrated in the lung apices . No pleural effusion or pneumothorax is seen . No acute osseous abnormalities are definitely noted .
    OUTPUT:
    
1 . Left apical opacification concerning for malignancy . Further assessment with chest CT is recommended . 2 . Bullous emphysema .