Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There are innumerable bilateral pulmonary nodules . There is no large effusion , although small left pleural effusion is possible . The cardiomediastinal silhouette is within normal limits . Left chest wall dual lead pacing device is noted . No acute osseous abnormalities .
    OUTPUT:
    
Innumerable bilateral pulmonary nodules . Please correlate with patient 's history regarding possible malignancy as metastases would be of greatest concern . Additional workup will be necessary .