Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Chain sutures in the lungs bilaterally are re- demonstrated compatible with prior wedge resections . Panlobular and centrilobular emphysema is re - demonstrated with chronic interstitial and nodular abnormality , most pronounced in the upper lobes , likely reflecting areas of bronchiectasis , scarring , and known pulmonary nodules better assessed on the previous CT . The cardiac and mediastinal contours are unchanged with the heart size within normal limits . Rightward shift of mediastinal structures is unchanged . Spiral tacks are seen along the left hemidiaphragm compatible with prior diaphragmatic hernia repair , and the left hemidiaphragm remains elevated . The pulmonary vasculature is not engorged . No new focal consolidation , pleural effusion or pneumothorax is seen . Multiple remote left - sided rib fractures are re - demonstrated .
    OUTPUT:
    
Centrilobular and panlobular emphysema with chronic interstitial abnormality and nodules , as seen on the previous exams . Evidence of prior left diaphragmatic hernia repair and remote left - sided rib fractures . No substantial interval change from the previous exams .