Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperinflated , consistent with COPD . There is moderately to moderately severe cardiomegaly with a calcified unfolded aorta . Prominence of the pulmonary hila with tapered appearance raises question of pulmonary hypertension . No widening of the mediastinum is detected . There is small amount of pleural fluid or thickening at the left lung apex and a small nodular opacity measuring approximately 4 .9 mm seen laterally between the posterior fourth and fifth ribs . A very tiny left apical pneumothorax is likely present . Probable pleural thickening along the right lung apex as well . There is minimal atelectasis at the left greater than right lung bases . Small posterior left effusion noted on the lateral view . Multiple left - sided rib fractures and left midclavicualr fracture are again noted , without appreciable displacement . Evidence for chronic bilateral rotator cuff tears again seen .
    OUTPUT:
    
1 ) Compared with ___ , there is new minimal atelectasis at the left base . Trace left pleural effusion noted posteriorly on the lateral view . Otherwise , no significant change . Tiny left apical pneumothorax remains visible . 2 ) No CHF .