Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Hyperinflation and flattening of the diaphragms consistent with emphysema . Enlarged right pulmonary artery consistent with pulmonary hypertension . No pleural effusion or pneumothorax is seen . The cardiac and mediastinal silhouettes are unremarkable .
    OUTPUT:
    
1 . No evidence of malignancy on chest x-ray however if patient is qualified , recommend further evaluation with chest CT . 2 . Emphysematous changes . 3 . Pulmonary hypertension likely secondary to COPD .