Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: AP upright and lateral views of the chest provided . Midline sternotomy wires and mediastinal clips are noted with coronaries dense . There is a chronic right pleural effusion which may be slightly increased from prior CT . There is increased opacity in the right mid to upper lung which raises concern for worsening metastatic disease versus a superimposed pneumonia . Scattered nodular opacities in the left lung consistent with metastatic disease . The heart is stably enlarged . The mediastinal contour is also unchanged . Bony structures are intact .
    OUTPUT:
    
Increased right pleural effusion , increased opacity in the right mid to upper lung concerning for worsening metastatic disease , less likely pneumonia .