CT
The abnormality on the chest x-ray corresponds to a large, heterogeneous mass lesion in the lingula segments of the left upper lobe. There is an abrupt cutoff of the lingula segmental bronchus consistent with endobronchial extension. Ground glass consolidation adjacent to the mass may relate to tumour infiltration or post obstructive change.
The mass has broad pleural abutment against the chest wall, oblique fissure and pericardium. There are pushing margins against oblique fissure, with interlobular septal thickening and ground glass in the adjacent left lower lobe consistent with local invasion across the visceral pleura. Loss of the fat plain in the left 5th intercostal space suspicious for chest wall invasion.
Contiguous heterogeneous soft tissue invading into the left superior pulmonary vein and into the left atrium (tumour thrombus). Additional focal thrombus in the right inferior pulmonary vein.
Bulky lymphadenopathy in the ipsilateral and contralateral hila and mediastinum.
Pericardial effusion. Small left pleural effusion.
No adrenal masses. Subcentimetre hypodensities in the liver are non-specific and too small to characterise.