The surgery or biopsy was performed in a different hospital and we do not have access to the same. The chart mentions unresectable cardiac fibroma. The ICD was also placed elsewhere for unresectable calcified cardiac fibroma causing arrhythmia.

When one sees an ICD on chest radiograph a radiologist should have a thought process as to why it was placed.

One should be curious to see the chart even though we were given COPD as ordering history.

There is a low dose CT chest in PACS to see this in correlation.

https://cortex.acr.org/CiP/Pages/CaseView?Info=+35fRWXorFyXb7QYX9eE7g=%3d

This link to ACR case in point has a nice case discussion.