Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart size remains moderately enlarged . Mediastinal lymphadenopathy is again demonstrated , similar compared to the prior CT torso . Multiple ill - defined nodular opacities are noted in both lungs , which have certainly progressed when compared to the prior chest radiograph from ___ and appear increased in size when compared to the prior CT torso , allowing for differences in modalities . Small right pleural effusion is slightly increased when compared to the prior study . No pulmonary edema is definitely noted . Patchy opacity in the right lung base may reflect compressive atelectasis and / or pulmonary vascular congestion , though infection can not be completely excluded . No pneumothorax is identified . No acute osseous abnormality is seen . There are degenerative changes in the thoracic spine .
    OUTPUT:
    
Interval increase in size of ill - defined nodular opacities in both lungs compatible with pulmonary metastases . Small right pleural effusion has increased when compared to the prior chest radiograph , with patchy ill - defined opacity in the right lung base which may reflect atelectasis though infection is not completely excluded . Mediastinal lymphadenopathy is re-demonstrated .