FINDINGS:
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.

IMPRESSION:
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.