Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The cardiac silhouette size is normal . The aortic knob is calcified . Mediastinal contours are unchanged . Mild pulmonary vascular congestion is noted . A moderate size right pleural effusion may be minimally increased in size compared to the prior exam . Lungs are hyperinflated with emphysematous changes again noted . Bibasilar patchy opacities are also more pronounced compared to the prior study , and could reflect areas of atelectasis though infection is not excluded . No pneumothorax is identified . Scarring within the lung apices is re - demonstrated . There are no acute osseous abnormalities .
    OUTPUT:
    
Moderate size right pleural effusion , slightly increased compared to the prior study , with mild pulmonary vascular congestion . Emphysema . Patchy opacities in lung bases may reflect areas of atelectasis though infection is not completely excluded .