Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: A portable upright frontal chest radiograph demonstrates a normal cardiomediastinal silhouette . The lungs are hyperinflated with lower lobe interstitial reticular markings compatible with known COPD and emphysema . There is a large right lower hemithorax pneumothorax , with a possible element of tension . Followup chest radiograph 4 .5 hours later demonstrates interval chest tube placement with improved lung inflation . There is unchanged subcutaneous emphysema along the chest walls bilaterally and imaged lower neck .
    OUTPUT:
    
Increased right lower hemithorax pneumothorax , now large . Chest radiograph from 4 .5 hours later demonstrates interval placement of a chest tube with improved inflation of the right lung .