Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size and mediastinal contours are stable . Median sternotomy wires are unchanged . The patient has known severe upper lobe predominant centrilobular emphysema better seen on prior CT . Distortion of the architecture , bilateral pleural thickening with scarring , granuloma of the left apex and hyperinflated lungs are unchanged . No pleural effusion or pneumothorax . Old healed right clavicular fracture is unchanged .
    OUTPUT:
    
Stable appearance of the chest with no acute process .