Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart size appears mildly enlarged , similar to that seen previously . Mediastinal contour is unchanged . Numerous masses in the lungs bilaterally compatible with metastases have increased in size and number . A large right pleural effusion has substantially increased in size from the previous study with associated right basilar atelectasis . Streaky atelectasis is noted in the left lung base . There is no pneumothorax . There are moderate degenerative changes in the imaged thoracic spine with partially imaged posterior fusion hardware spanning the lower thoracic and upper lumbar spine .
    OUTPUT:
    
Substantial interval increase in size of right pleural effusion , now large , with right basilar atelectasis . Increased size and number of multiple metastases within the lungs .