Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lungs remain hyperinflated with flattened diaphragms and extensive emphysematous changes again noted . The heart size is normal . Enlargement of the pulmonary arteries bilaterally is re - demonstrated suggestive of underlying pulmonary arterial hypertension . Mediastinal contour is unchanged . Pulmonary vasculature is not engorged . Small bilateral pleural effusions are demonstrated , mildly increased in size on the right since the prior study . Patchy opacities in the lung bases likely reflect areas of atelectasis . Multiple pulmonary nodules seen on prior chest CT are not as well demonstrated on the current exam . No pneumothorax or new focal consolidation is present . Mild loss of height of a mid thoracic vertebral body is similar .
    OUTPUT:
    
Severe emphysema with mild bibasilar atelectasis and small bilateral pleural effusions , slightly increased in size on the right compared to prior . Enlarged pulmonary arteries suggestive of underlying pulmonary arterial hypertension . No new focal consolidation .