FINDINGS:
The lungs are hyperexpanded, compatible with COPD and emphysema. No pleural
 effusion or pneumothorax. Stable lucency of the right lower lung. New opacity
 is noted obscuring the left heart border.  Chronic right middle lobe collapse
 noted. Heart, mediastinal contour, and hila are otherwise unremarkable.
 
 Old right lateral rib fracture. Stable mild compression deformity of a lower
 thoracic vertebral body. Limited assessment of upper abdomen is unremarkable.

IMPRESSION:
1.  New opacity obscuring left heart border is worrisome for a lingular
 pneumonia. Clinical correlation recommended.
 2.  COPD/emphysema.
 3.  Chronic right middle lobe collapse.