Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The hyperinflated lungs are clear . The hilar and cardiomediastinal contours are normal . There is a small calcified granuloma in the left upper lobe , stable from the prior study . Bilateral apical pleural scarring is also unchanged . There is atherosclerotic calcification of the aortic arch as well as stable tortuosity . There is no gross rib deformity .
    OUTPUT:
    
1 . No evidence of pneumonia . 2 . No acute rib fracture is seen ; however , this study is not optimal for the detection of subtle nondisplaced rib fractures . If there is continued clinical concern , a dedicated rib series is recommended . 3 . Findings suggestive of COPD .