Pre-chemotherapy CT performed 10 days earlier shown in series 2 and 4.
Irregular mass in the right lung apex (arrow) is associated with a large right adrenal mass lesion with central low density indicative of necrosis (arrow). Right lung base is clear. Subsequent CTPA shows marked right lung atelectasis with pleural fluid with a dramatic increase in size of the metastasis with central high denisty indicative of haemorrhage (arrow). This explains the right sided pleuritic symptoms and hypotension. No signs of PE.