IMPRESSION:
Cardiac mediastinal contours are within normal limits.  Bilateral lower lobe
 nodular opacities are felt to represent nipple shadows.  Lungs appear well
 inflated without evidence of focal airspace consolidation, pleural effusions
 pneumothorax or pulmonary edema.  Given the patient's smoking history,
 screening with CT should be considered given its higher sensitivity to detect
 malignancy.