IMPRESSION:
Stent catheters in both brachiocephalic veins, joining at the origin of the
 SVC, have not narrowed or migrated since .
 Severe hyperinflation reflects emphysema.  Heart size is top-normal, improved
 since .  There is no focal pulmonary abnormality.  Previous left lower
 lobe atelectasis has resolved and there is no pleural effusion.  Severe renal
 osteodystrophy is responsible for the appearance of the thoracic spine.