Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Heart size is normal . The mediastinal contour is unchanged with mild atherosclerotic calcifications noted at the aortic arch . Hilar contours are similar compared to the prior chest CT with an infrahilar opacity re - demonstrated . The lungs are hyperinflated with severe emphysematous changes again seen . While scarring within the lung apices is again noted , there is a new patchy opacity seen within the left upper lobe concerning for an area of infection . No pleural effusion or pneumothorax is identified . No acute osseous abnormality seen .
    OUTPUT:
    
1 . New patchy opacity in the left upper lobe concerning for an area of pneumonia . 2 . Severe emphysema with scarring within the lung apices . 3 . Right infrahilar opacity is re- demonstrated , and previously characterized on chest CTA as an area concerning for possible malignancy . Again bronchoscopy of this area is recommended if not done in the interval .