Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Since the next most recent study there is increasing paramediastinal opacity in the left upper lobe . Again several surgical clips project at the left apex . There is new elevation and tenting of the left hemidiaphragm . The right lung is relatively clear . The heart is not enlarged . There is no pleural effusion or pneumothorax .
    OUTPUT:
    
Evolving paramediastinal opacity in the left upper lobe and elevation of the left hemidiaphragm may relate to radiation therapy or pneumonia , however tumor growth can not be excluded . If clinically indicated this can be further evaluated with CT of the chest .