Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size is normal . Mediastinal and hilar contours are unchanged . Right PICC has been removed . Lungs remain hyperinflated with emphysematous changes again noted . Small left pleural effusion is similar compared to the prior study . There is no focal consolidation or pneumothorax . Minimal left basilar atelectasis is present . There are mild degenerative changes in the thoracic spine .
    OUTPUT:
    
Small left pleural effusion . Persistently hyperinflated lungs with emphysema .