Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are mildly hyperinflated with flattening of the diaphragms , unchanged in appearance since prior examination . Lungs are otherwise clear . No pleural effusion or pneumothorax . Heart size , mediastinal contour , and hila are unremarkable . There are intact median sternotomy wires . A left anterior chest wall pacemaker device lead tips are in the right atrium and right ventricle . Limited assessment of the osseous structures are notable for chronic left rib deformities and chronic mid left clavicular fracture .
    OUTPUT:
    
1 . No acute cardiopulmonary process . 2 . Although no acute fracture or other bone abnormality is seen , conventional chest radiographs are not appropriate for detection or characterization of chest cage lesions . Any focal findings should be clearly marked and imaged with either bone detail views or CT scanning . 3 . Hyperinflated lungs suggestive of emphysema and chronic obstructive pulmonary disease .