Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Right PICC tip terminates in the mid SVC . Heart size is normal . Patient is status post esophagectomy and gastric pull - through with unchanged mediastinal contour . Emphysematous changes are most pronounced in the upper lobe . A fiducial marker is noted within a spiculated lesion in the right apex , not substantially changed from the prior study , with associated apical pleural thickening . Atelectasis is seen in the right lung base . A trace left pleural effusion is likely present . No focal consolidation or pneumothorax is identified . Post thoracotomy changes are seen in the right chest .
    OUTPUT:
    
Re - demonstration of spiculated lesion in the right apex with associated pleural thickening . Upper lobe predominant emphysema . Status post esophagectomy and gastric pull - through with associated right basilar atelectasis . Trace left pleural effusion .