Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-upright radiograph of the chest demonstrates persistent small bilateral pleural effusions with adjacent atelectasis , not significantly changed from the prior study . Again seen are multiple bilateral pulmonary nodules , consistent with metastatic disease . The cardiomediastinal and hilar contours are unchanged . Two chest tubes project over the left hemithorax . Left - sided oral pacemaker is present with the leads in the appropriate position . There is no pneumothorax .
    OUTPUT:
    
Bilateral pleural effusions with adjacent atelectasis are not significantly changed from the prior study .