A 56-year-old female presents to clinic for follow-up after recent hospitalization for COPD exacerbation. The patient is currently stable and without acute complaints. She has a 52-pack year smoking history and refuses to be counseled on tobacco cessation. Vital signs are within normal limits. Physical examination reveals a thin female with decreased breath sounds bilaterally and a raspy voice. Osteopathic structural examination would likely reveal which of the following diagnoses?