Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The study is somewhat limited by lordotic positioning . Moderate to severe cardiomegaly is unchanged . Mediastinal and hilar contours are grossly similar . Lungs are clear without focal consolidation . Diaphragms remain flattened raising the possibility of COPD . No large pleural effusion or pneumothorax is present . Chronic blunting of the costophrenic angles posteriorly on the lateral view may reflect chronic pleural thickening or trace bilateral pleural effusions . Pulmonary vasculature is not engorged . There are mild to moderate multilevel degenerative changes seen in the thoracic spine .
    OUTPUT:
    
No acute cardiopulmonary abnormality . Chronic blunting of the costophrenic angles posteriorly may reflect chronic pleural thickening or trace bilateral pleural effusions aerated