Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right - sided chest drain in situ . Interval improvement in the bilateral chest wall subcutaneous emphysema . Extensive bilateral upper lobe emphysematous changes . Bronchovascular crowding seen in the lower lobes with a small component of posterior basal pulmonary fibrosis . No pneumothorax . Old right - sided mid clavicular shaft fracture unchanged . Malalignment of the left acromioclavicular joint .
    OUTPUT:
    
No pneumothorax . Imaging findings suggestive of combined pulmonary fibrosis and emphysema . Although the pulmonary arteries does not appear significantly enlarged , pulmonary hypertension should be excluded .