FINDINGS:
The lungs are hyperinflated, consistent with severe emphysema.  A poorly
 defined nodular seen in the right lung apex, is again demonstrated and is
 possibly slightly increased in size in the interval.  Lungs are otherwise
 clear.  No pleural effusion or pneumothorax.  The cardiomediastinal silhouette
 is unremarkable.

IMPRESSION:
Nodular opacity in the right lung apex has apparently increased in size since
  but is difficult to assess radiographically due to
 overlapping osseous structures.  Recommend CT for further assessment.
 
 RECOMMENDATION(S):  CT follow-up of apical right lung opacity.  The