Chest: There is a large right upper paratracheal mass that is heterogeneously enhancing with hypodense regions medially. The enhancing component has spiculated margins extending to the pleural surfaces. No destruction of the adjacent ribs or vertebrae. Hypodense right hilar lymph node. No other mediastinal, hilar or axillary lymphadenopathy.
Biapical paraseptal and centrilobular emphysema. Mild left sided pleural thickening predominately posteriorly and basally with some nodular regions. High-density pleural thickening at the left apex with thin linear calcifications.
Conclusion: Enhancing right paratracheal mass with regions of low attenuation. This may either represent a conglomerate of lymph nodes or alternatively a primary lung mass with adjacent lymphadenopathy. Given the central low-density tuberculosis needs to be considered. Note is made of emphysematous changes suggestive of a smoking history.