FINDINGS:
In comparison to prior study from , there has been
 in increase in both size and number of multiple bilateral pulmonary nodules.
 While the right upper lobe opacity with volume loss has remained stable, there
 is a new, confluent, consolidative left perihilar opacity. This new opacity is
 centered in the lingula but also involves the left upper lobe.  
 Again visualized is a collapsed T11 vertebral body as noted previously. 
 However, multiple known metastatic lesions throughout osseous structures are
 not clearly visualized on today's study.

IMPRESSION:
1. There is a new, confluent, consolidative left perihilar opacity centered in
 the lingula with involvement of the left upper lobe. This opacity is most
 consistent with a lingular pneumonia.
 
 2. Multiple small bilateral pulmonary nodules have increased in both size and
 number and are suspicious for worsening of metastatic lung disease. 
 
 3. Right upper lobe atelectasis appear stable. 
 
 These findings were discussed by Dr.  with Dr.  via
 telephone at 2:40 pm on .