Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart size is at the upper limits of normal ; a pacer unit projects over the left chest with the lead terminating in the right ventricle . Calcified atherosclerotic disease is present at the aortic knob . Known metastatic lesions in bilateral mid lungs are present . The right hilus is more prominent than on prior exams , suggesting progression of metastatic disease . Bibasilar opacities are present . There is no large pleural effusion or pneumothorax . Severe degenerative changes are present in the right glenohumeral joint and a prosthetic humeral head is present on the left .
    OUTPUT:
    
1 . Pulmonary metastases with increasing prominence of the right hilus , possibly representing progressive lymphadenopathy . 2 . COPD . 3 . Bibasilar opacities represent either atelectasis or pneumonia .