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There is extensive central pulmonary embolus including a saddle embolus crossing the bifurcation of the pulmonary trunk. There is near occlusive embolus throughout the main pulmonary arteries bilaterally, slightly more extensive on the right.

On the right side there is occlusive embolus of upper lobar pulmonary arterial branches and partial occlusion of middle and lower lobar pulmonary arterial branches. 

Similarly, on the left side, there is occlusion of antero-apical segmental arteries to the left upper lobe, partial occlusion of the apical posterior segmental branches and occlusion of lingular branches. Partial occlusion of left lower lobar segmental pulmonary arterial branches. 

Right atrial and ventricular dilatation is evident along with contrast reflux into the IVC and straightening of the IV septum consistent with right heart strain. No pleural or pericardial effusion.  No pulmonary consolidation, collapse, region of haemorrhage or evolving infarction demonstrated. 

Bilateral axillary lymphadenopathy and upper anterior mediastinal lymphadenopathy is demonstrated.