Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: New right upper lobe opacity with associated volume loss causing ipsilateral tracheal deviation . Otherwise , bilateral fibrotic changes appear essentially unchanged since ___ . Multiple perihilar granulomas are again noted . No pleural effusion or pneumothorax . Heart size is normal . Cardiomediastinal hilar silhouettes are unchanged .
    OUTPUT:
    
Right upper lobe opacity with apparent associated volume loss is suspicious for parenchymal lesion , though shadows from overlapping structures is possible . Recommend apical - lordotic radiographs for further evaluation .