Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart size is large . The mediastinal and hilar contours are normal . The lungs show emphysematous changes . There is no pleural effusion or pneumothorax . Apical pleural thickening is noted . A compression deformity of the spine is unchanged since ___ .
    OUTPUT:
    
Cardiomegaly and emphysema , but no acute cardiopulmonary process .