Metastatic throid cancer and rib osteochondroma
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There is extensive mediastinal and right and left hilar lymph adenopathy. Surgical clips in the right neck in keeping with previous thyroidectomy.
Calcified lesion is right fifth rib anterior aspect is an osteochondroma.
Surgical clips in the neck give the cause of the nodal disease away - the patient had a thyroidectomy a year before for medullary thyroid cancer.
The rib lesion is calcified and there is loss of the rib cortex confirming it arising from the rib rather than the lung or pleura. It also has the typical calcification for an osteochondroma.