Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: There are innumerable nodules randomly distributed in both lungs , increased compared to prior study with increased interstitial changes in the lungs bilaterally . Small right - sided pleural effusion is mildly increased . The cardiomediastinal silhouette appears similar . There is no focal consolidation . There is no pneumothorax .
    OUTPUT:
    
Worsening diffuse bilateral interstitial and nodular opacities may represent worsening metastatic disease however superimposed atypical infection or mild interstitial pulmonary edema can not be excluded . Small right - sided pleural effusion is slightly increased .