Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: New moderate to large pleural effusion . Pulmonary nodules partially visualized in the right upper lobe as well as in the left lower lobe are pulmonary metastases . Cardiac silhouette is similar in size . No pneumothorax .
    OUTPUT:
    
New moderate to large pleural effusion . Substantially increased since ___