FINDINGS:
Heart size is normal.  Mediastinal and hilar contours are unremarkable. 
 Pulmonary vascularity is normal.  The lungs are hyperinflated with severe
 emphysema.  Punctate calcified granulomas are seen within the lung bases. 
 Linear opacities in the lung bases likely reflect scarring or subsegmental
 atelectasis.  Residual patchy opacity within the left upper lobe likely
 reflects scarring, as seen on the prior chest CT.  No new consolidation,
 pleural effusion or pneumothorax is identified.  Scarring within the lung
 apices is again noted.  There is diffuse demineralization of the osseous
 structures.

IMPRESSION:
No acute cardiopulmonary abnormality.  Severe emphysema.  Residual left upper
 lobe opacity likely reflects scarring, as seen on the prior chest CT, with
 bibasilar linear opacities either reflecting subsegmental atelectasis or
 scarring.