Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The tracheostomy tube midline and unchanged . The right subclavian and brachiocephalic vein stent appears similar to prior . The left brachiocephalic stent is unchanged . The vascular catheter coursing through the IVC terminates in SVC . The diffuse bilateral lung opacities have increased slightly . This is concerning for multifocal pneumonia . The opacities in the left lung appears or nodule and discrete . With known history of squamous cell carcinoma of the tongue , nodular metastases is on the differential . Bilateral lower lobe atelectasis is stable . The mild to moderate right pleural effusion is stable . Minimal pleural effusion in the left lung . No pneumothorax . Mediastinal silhouette is unchanged . Splenic ossification is again seen and unchanged . The visualized vertebrae appear more sclerotic which could represent osseous metastases .
    OUTPUT:
    
1 . Increased diffuse opacification is concerning for multifocal pneumonia . 2 . The left lung discrete nodular opacities are also worrisome for nodular metastases . 3 . The sclerotic vertebrae are concerning for osseous metastases .