Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The heart is markedly enlarged . A convex contour to the left upper cardiac border suggests the likelihood of left atrial appendage enlargement . The aorta is calcified and tortuous , probably also somewhat ectatic but unchanged . Nodular opacities are again present including one projecting over the left upper lobe measuring about 21 mm in diameter and one projecting over the right mid lung of 17 mm in diameter . These are concerning for lung nodules . There is a background interstitial abnormality , but increased , suggesting superimposed pulmonary vascular congestion . The chest is hyperinflated . Fissures are thickened , a new finding . New small pleural effusions are suspected . Several mid thoracic compression deformities appear unchanged .
    OUTPUT:
    
Multiple suspicious nodules worrisome for metastatic disease . Increased interstitial abnormality suggesting pulmonary vascular congestion . Similar ony demineralization and compression fractures , stable . A chest CT is suggested to assess further when clinically indicated .