Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest . Again seen are multiple bilateral pulmonary nodules compatible with metastatic disease . There is a small right - sided pleural effusion similar to prior . There is no definite new consolidation . Elevation of the right hemidiaphragm is similar to prior . The cardiomediastinal silhouette is unchanged . No definite acute osseous abnormality or fracture identified on this nondedicated exam .
    OUTPUT:
    
Metastatic disease and right pleural effusion , similar to prior . No definite acute fracture on this nondedicated exam . If desired , dedicated rib series could be performed .