Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Left - sided pacer device is noted with leads terminate in the right atrium right ventricle . Heart size is difficult to assess given the presence of moderate bilateral pleural effusions , increased since the previous study , and larger on the right . There is associated bibasilar atelectasis . The aorta remains mildly tortuous and diffusely calcified . Hilar contours are obscured . There is no pulmonary edema . Innumerable nodules within both lungs are compatible with metastases . No acute osseous abnormalities detected . Multiple clips are noted in the right neck .
    OUTPUT:
    
Increased size of bilateral moderate size bilateral pleural effusions , larger on the right with bibasilar atelectasis . Innumerable pulmonary metastases , not substantially changed in the interval .