Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Lungs are slightly hyperinflated . Bibasilar atelectasis is minimal . There is otherwise no consolidation , effusion or pneumothorax . Upper lobe predominant emphysematous changes are severe . Surgical chain sutures are noted in the right upper lung . Cardiomediastinal contours are normal . No acute osseous abnormalities identified . A hiatal hernia is noted .
    OUTPUT:
    
Severe upper lobe predominant emphysematous changes , without evidence of pneumonia .