What differentials to include in this case? Which one is favoured and why?
Metastatic disease is favoured over a lung primary given the distribution and appearances of the lesions: bilateral large circumscribed lung masses without nodal disease and a pelvic mass. Given the remainder of the srudy is unremarkable, melanoma is the most favoured aetiology in this caucasian patient living in Australia.
There are bilateral well-defined solid lung masses, two on the left lower lobe and one in the right upper lobe. Small left-sided pleural effusion without clear pleural nodularity. No mediastinal lymphadenopathy.
In the abdomen, there is a solid well-defined mass left pelvic side-wall/extraperitoneal mass. The remainder of the study is unremarkable.