Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The patient is rotated with his neck turned to the right . The tip of the tracheostomy tube appears appropriately positioned and unchanged . The configuration of the right subclavian vein and brachiocephalic vein stent appears similar to the prior chest CT with kinking of the stent at the level of the clavicle . The configuration of the left brachiocephalic vein stent is also similar to the prior CT . Bilateral right worse than left parenchymal opacities have progressed from the prior radiograph as well as CT , again concerning for multifocal infection and / or metastases . A right pleural effusion may be trace . The left pleural effusion may have resolved in the interim . No pneumothorax . The heart is normal in size . Mild prominence of the right mediastinum may correspond to the known mild ascending thoracic aortic aneurysm on prior CT . The size of the mediastinum is similar to the prior exam . Calcified right mediastinal lymph node is unchanged . Catheter projecting over the lower portion of the SVC is unchanged . Coils projecting over the left upper abdomen are also unchanged . Coarse calcifications projecting over the left upper abdomen are unchanged from the prior radiograph in correspond to splenic calcifications on the prior CT . Coarse calcifications in the soft tissue of the neck are unchanged from prior CT neck .
    OUTPUT:
    
1 . Interval progression of bilateral , right worse than left parenchymal opacities again concerning for multifocal infection and / or metastases . 2 . Similar appearance of the mediastinum . 3 . Probable small right pleural effusion , new from the prior exam . 4 . Position of vascular stents with kinking of the right brachiocephalic / axillary vein stent is similar to the prior chest CT .