Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable semi-upright radiograph of the chest demonstrates persistent small left - sided pleural effusion , which is not significantly changed . A small right - sided pleural effusion is also seen , and is slightly increased in size over the interval . Again seen are multiple bilateral nodules in the lungs consistent with metastatic disease . The cardiomediastinal and hilar contours are unchanged . Two chest tubes project over the left hemithorax .
    OUTPUT:
    
Persistent small left - sided pleural effusion with adjacent atelectasis , and slight interval increase in size in the small right pleural effusion .