Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperinflated with reduced lung markings and flattening of the hemidiaphragms consistent with severe COPD . Focal pleural thickening at the periphery of the right upper lung was not seen on prior chest CT or chest radiograph and is concerning for infection versus malignancy . No pleural effusion or pneumothorax is seen . The cardiac , hilar and mediastinal silhouettes are unremarkable .
    OUTPUT:
    
Focal pleural thickening at the periphery of the right upper lung may represent infection , including tuberculosis , or malignancy . Recommend chest CT for further evaluation .