Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Upright AP and lateral views of the chest demonstrate the lungs are hyperexpanded , consistent with underlying COPD . There is no evidence of pneumothorax , pulmonary edema , pleural effusion or focal consolidation . The heart size is top - normal . The aorta is tortuous , as before . Median sternotomy wires and vascular clips are again seen . A tendon anchor is present in the left humeral head .
    OUTPUT:
    
No acute cardiopulmonary process . Emphysema . Conventional chest radiography is insensitive for the detection of rib fractures , and if clinically suspected , dedicated rib views are recommended . A page was sent to ___ ( ___ NP ) by Dr . ___ at 8 : 54 am , and the findings were subsequently discussed over the telephone with Dr . ___ at 9 :06 am .