Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Numerous bilateral pulmonary nodules are again identified , better evaluated on recent CT . Hyper expansion of the left upper lobe is again noted . No pleural abnormalities . Heart size is normal . Cardiomediastinal and hilar silhouettes are unchanged . Dual chamber cardiac pacemaker leads are unchanged in position with leads terminating in the right atrium and right ventricle . Dense aortic arch calcifications are again noted . Known rib lesions are seen to better detail on recent CT .
    OUTPUT:
    
1 . Cardiac pacemaker leads terminate in the right atrium and right ventricle . 2 . Numerous bilateral pulmonary nodules reflect known metastatic disease , better evaluated on recent CT .