Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are again noted to be hyperinflated . Heart size is top normal and unchanged . The aorta is calcified and mildly tortuous . No focal consolidations , pleural effusions , or pneumothorax is detected . Underlying emphysema is present . Blunting of the left costophrenic angle on the lateral view posteriorly may reflect pleural thickening . Pectus excavatum is again noted .
    OUTPUT:
    
Emphysema and top normal heart size , unchanged , without radiographic evidence for acute process .