Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Frontal and lateral views of the chest . Again seen is elevation of the right hemidiaphragm , similar in configuration compared to prior exam . Multifocal predominantly basilar rounded opacities are compatible with known metastatic lesions . The lungs are clear of new consolidation or effusion . The cardiomediastinal silhouette is unchanged . No acute osseous abnormality detected . Multiple air - fluid levels identified in small bowel loops which are distended worrisome for small bowel obstruction .
    OUTPUT:
    
Evidence of pulmonary metastatic disease as seen on prior exam . Findings worrisome for small bowel obstruction . CT scan had already been performed at time of this dictation .