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Chest

Approximately 5cm x 5cm hypodense mass in the right atrium has extension into the right ventricle consistent with tumour thrombus. Hypodensities within the left lower lobar pulmonary artery likely also represents tumour thrombus.

There is bilateral lower lobe ground-glass opacification. Bilateral pulmonary nodules have been marked with arrows, the largest measuring 4mm. A 9mm pleurally-based nodule is identified in the right upper lobe. Small right pleural effusion.

Trace pericardial effusion.

There is axillary lymphadenopathy with the largest node identified in the right axilla and measuring 50mm x 38mm in maximal axial dimensions. No mediastinal or hilar lymphadenopathy.

No destructive osseous lesion.

Neck

Jugular chain and submandibular lymphadenopathy. The largest node in the left jugular chain measures 16mm x 12mm. The right palatine tonsil is markedly enlarged with narrowing of the airway (which remains patent).

The parotid glands are normal. There are bilateral subcentimetre hypodense thyroid nodules. The internal jugular veins are patent.

Conclusion

• Right atrial and left lower lobe pulmonary artery masses are likely tumour thrombus - echocardiography recommended if not already performed.
• Cervical and axillary lymphadenopathy.
• Subcentimetre pulmonary nodules.