Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Again seen is hyperinflation and parenchymal distortion consistent with COPD . Also again seen is marked cardiomegaly with prominence of the main pulmonary artery and a calcified , slightly unfolded aorta . Probable mitral annulus calcifications . There is upper zone redistribution and mild vascular plethora , without overt CHF . Possible minimal blunting of left costophrenic angle , less than on ___ . No focal consolidation or gross effusion is identified . Severe glenohumeral osteoarthritis this is seen bilaterally . Marked deformity of the humeral head raises the question of humeral head osteonecrosis in both shoulders .
    OUTPUT:
    
1 . Hyperinflation , consistent with COPD . 2 . Marked cardiomegaly , unchanged . 3 . Mild vascular plethora , less pronounced than in ___ . 4 . No focal opacity to suggest an acute pneumonic infiltrate on this AP view . 5 . Interval improvement in small left effusion , with residual minimal blunting of the left costophrenic angle . 6 . Severe glenohumeral osteoarthritis bilaterally . Possibility of bilateral humeral head osteonecrosis can not be excluded .