Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size remains mildly enlarged . The aorta is tortuous , and enlargement of the main pulmonary artery is again suggestive of underlying pulmonary arterial hypertension . Lungs are hyperinflated with severe emphysematous changes again noted . No pulmonary edema is demonstrated . Patchy and somewhat nodular opacities within the right upper lobe as well as within both lower lobes likely reflect areas of bronchiectasis with mucoid impaction , bronchial wall thickening , and inflammation . The findings in the right upper lobe appear relatively unchanged compared to the previous radiograph , with the opacities in the lung bases appearing more evident . No large pleural effusion or pneumothorax is present .
    OUTPUT:
    
Worsening patchy and somewhat nodular opacities in both lung bases which may reflect exacerbation of chronic airways disease and bronchiectasis . Relatively similar appearance of patchy and nodular opacities in the right upper lobe . Severe emphysema .