Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Numeral bilateral pulmonary nodules / masses are again seen . The largest is located within the right lower lobe with some areas of central lucency better seen on the lateral view and prior chest CT . Small bilateral pleural effusions are noted . There is a moderate hiatal hernia . Cardiomediastinal silhouette is otherwise unremarkable . No acute osseous abnormalities .
    OUTPUT:
    
Diffuse bilateral pulmonary metastases . Given significant burden of disease , evaluation for subtle new opacity is limited although none is definitively seen .