Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Cardiac silhouette size is normal . Endobronchial valves again are seen projecting over the left hilar region . Mediastinal and hilar contours are unchanged . There is no pulmonary vascular congestion . Lungs are hyperinflated with marked upper lobe predominant emphysema . Left upper lobe atelectasis is re - demonstrated . No focal consolidation , pleural effusion or pneumothorax is present . The osseous structures are diffusely demineralized with similar height loss of a mid thoracic vertebral body .
    OUTPUT:
    
No substantial interval change from prior . Marked emphysema with left endobronchial valves re - demonstrated .