Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP portable semi upright view of the chest . Multiple calcified lymph nodes again seen projecting over the chest and neck . The previously noted tracheostomy tube is no longer seen . Calcified pleural plaque along the right hemidiaphragm noted along with multiple bilateral calcified pulmonary nodules . A small right pleural effusion is likely present . No convincing signs of pneumonia . The cardiomediastinal silhouette appears grossly within normal limits . Severe degenerative disease at both shoulders is again noted .
    OUTPUT:
    
No convincing evidence for pneumonia . Chronic changes as detailed above .