Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable upright chest radiograph was provided . Lungs are hyperinflated . Subtle opacity in the lower lungs is most compatible with scarring , though a dedicated PA and lateral view may be obtained to further assess . No large pleural effusion or pneumothorax is seen . Cardiomediastinal silhouette is stable . Bony structures are intact .
    OUTPUT:
    
COPD with presumed scarring in the lower lungs as compared with multiple prior exams . If there is strong clinical concern for pneumonia , recommend a dedicated PA and lateral view to further assess .