Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Consistent with the given history , a chest tube is noted and is directed medially in the upper mediastinum with a location that is highly suggestive of intrafissural placement . There is increased lucency at the lung base , particularly outlining the right hemidiaphragm , which likely indicates a residual component of the pneumothorax . Diffuse bilateral pulmonary nodules consistent with widespread metastatic disease are again present . There is air noted around a ray cage device in the lower thoracic spine , surrounded by posterior spinal stabilization rods . Extensive surgical clips are noted within the medial left upper quadrant . It is difficult to discern the left hemidiaphragm . There is increased retrocardiac opacity , although similar to the prior exam . A Port - A - Cath is evident in stable and standard course and position . The osseous structures are difficult to assess , but are grossly stable .
    OUTPUT:
    
The course of the chest tube projecting over the right chest suggests an intrafissural position , which may limit the ability to evacuate the pneumothorax . A visceral pleural line remains evident and most apparent at the lung base with an extension of the air to the spinal hardware as noted on the CT earlier today . Widespread metastatic disease of the lungs is again seen . There is no radiographic evidence currently of tension physiology .