Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is status post sternotomy and aortic valve replacement . The heart is mildly enlarged . The mediastinal and hilar contours appear unchanged . A density projecting over the right upper lung and course of the right anterior third rib may reflect a flat subpleural opacity seen on the prior chest CT studies . It shows apparent increased conspicuity since the prior radiographs . Otherwise the lungs appear clear . There are no pleural effusions or pneumothorax .
    OUTPUT:
    
1 . No evidence of acute process . 2 . Apparent increase in nodular focus in the right upper lung , which may correspond to a previously seen subpleural opacity on prior chest CT . Although the possibility of true change is difficult to judge by comparing radiographs , since there is a suggestion of increase , a follow - up chest CT is recommended to evaluate further and exclude developing malignancy . An email regarding the recommendation for chest CT follow - up was sent to the ED ___ nursing group on ___ at 10 :30 pm .