Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: In the background of severe interstitial lung disease , which is predominantly reflected in fine reticulation of the lung periphery on each side , there are patchy superimposed opacities in the right upper lung as well as the left mid and lower lung worrisome for superimposed pneumonia . There is no pleural effusion or pneumothorax . The lung volume are again low . The cardiac , mediastinal and hilar contours appear unchanged , allowing for differences in technique .
    OUTPUT:
    
Multifocal opacities worrisome for pneumonia superimposed on severe underlying interstitial lung disease ; although recent prior radiographs are not available for comparison and progression of chronic lung disease could be considered as an alternative , acute superimposed pneumonia seems most likely .