Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Cardiomediastinal contours are stable with mild cardiomegaly and tortuous aorta . The lungs are hyperinflated . Small right pleural effusion with adjacent atelectasis has increased . Bilateral rib fractures are again noted ( new on the left , healed on the right ) . There is no pneumothorax .
    OUTPUT:
    
Increase in right pleural effusion and adjacent atelectasis . No evident pneumothorax COPD