FINDINGS:
PA and lateral chest views were obtained with patient in upright
 position.  Analysis is performed in direct comparison with the next preceding
 similar study of .  The heart size is at the upper limit of
 normal variation with a mild prominence of the left ventricular contour to the
 left, but absence of significant left atrial enlargement.  Thoracic aorta is
 moderately widened and elongated and shows some calcium deposits in the wall
 at the level of the arch.  No new local contour abnormality is present.  The
 pulmonary vasculature is not congested.  Pulmonary vasculature shows some
 regional distortion with some areas of increased translucencies in the left
 lung mid field.  This slightly abnormal distribution of the vasculature was
 not present at least to the same extent on the previous study.  On the other
 hand, a left lower lobe basal linear density in supradiaphragmatic position
 existed already at that time.  In the right hemithorax, similar somewhat
 irregular vascular distributions are noted, but are less prominent.  As they
 occur in conjunction with relatively low positioned and somewhat flattened
 diaphragms is suggestive of COPD.  There is no evidence of any acute
 parenchymal pulmonary infiltrate of pneumonic appearance and no evidence of
 pneumothorax exists in the apical area.  Skeletal structure of the thorax
 demonstrate a moderate degree of demineralization of the vertebral bodies in
 the thoracic spine with some moderate degree of degenerative changes, but no
 conclusive evidence of local skeletal destruction.

IMPRESSION:
No pulmonary vascular congestion.  General pulmonary findings
 suggestive of COPD without evidence of acute infiltrates.  No conclusive
 findings for any pulmonary malignancy, but as clinical suspicion exists,
 further evaluation with chest or torso CT may be indicated.