IMPRESSION:
Compared to chest radiographs since , most recently .
 
 Emphysema is severe and chronic.  It is responsible for the sagittal
 elongation of the trachea.
 
 Although the frontal chest radiographs suggests an abnormality in the right
 lower lung, the appearance of this area is unchanged over series of prior
 chest radiographs on lateral view shows no consolidation.  Most of the
 abnormality is due to redirection of blood flow from the emphysematous lung
 apices to the perfused bases.  There is bronchial wall thickening in the lower
 lobes and bronchitis is a more likely diagnosis than pneumonia or heart
 failure.
 
 Heart is normal size.  There is no pleural effusion.