Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Single frontal view of the chest demonstrates markedly decreased lung volumes , accentuating bilateral perihilar and scattered pulmonary renal cell carcinoma metastases . Ill - defined opacity in the right upper lung noted on CT from ___ may be beyond the resolution of current exam . There is no large pleural effusion or pneumothorax . Cardiomediastinal silhouette is within normal limits .
    OUTPUT:
    
Extensive bilateral pulmonary metastases may obscure subtle infection . Given extent of metastatic disease , if there is lingering clinical concern for pneumonia , consider CT evaluation if indicated .