Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-upright view of the chest demonstrates low lung volumes . Right costophrenic angle is blunted , suggestive of small pleural effusion . There is no left pleural effusion . No pneumothorax . Hilar and mediastinal silhouettes are unchanged . Heart is moderately enlarged . Pacemaker leads project over right atrium and right ventricle . A large destructive lesion involving the left shoulder is noted , which is slightly progressed since prior . Left scapula is not visualized . A soft tissue density projecting the anterior right fifth rib is new since prior and concerning for a new lytic metastatic lesion . Associated soft tissue mass is better seen on CTA chest of the same date . There is mild pulmonary vascular congestion . Lung volumes are low . Prominent air - filled loop of large bowel is seen in the left upper abdomen .
    OUTPUT:
    
1 . Low lung volumes . Moderate cardiomegaly . Vascular congestion . 2 . A large destructive soft tissue lesion involving the left shoulder joint has increased since prior . Right rib lesion is better assessed on CTA chest of the same date , is new since prior and is concerning for an additional metastatic focus .