Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperinflated , compatible with known emphysema . Probable small bibasilar pleural effusions are unchanged . No lobar consolidation or pneumothorax . Stable cardiomediastinal silhouette . A hiatal hernia is again noted .
    OUTPUT:
    
Severe emphysema and probable small bilateral effusions .