Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Innumerable metastatic lesions are again identified . The right pleural effusion has increased in size , with only a small area of aerated lung in the right upper lobe . There is leftward shift of mediastinal structures secondary to the mass effect . No pneumothorax is present .
    OUTPUT:
    
Interval increase in a now very large right pleural effusion with diffuse metastatic disease .