62-year-old male with acute shortness of breath and hemoptysis. Rule out PE. PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Severe emphysema. Right hilar and peribronchial thickening with adjacent interstitial and air space disease concerning for with lymphangitic spread of diseaseMEDIASTINUM AND HILA: Bulky AP window lymph nodes, the largest of which measures 2 x 2.6-cm, (image 37, series 6). and moderate pericardial effusion. Right hilar mass has ill-defined borders but grossly measures 4.7 x 4.1cm (image 86, series 8) which sounds and narrows the right upper lobe bronchus and right upper pulmonary artery. The distal aspect of the right upper lobe bronchus is narrowed measuring approximately 4 mm (image 36, coronal series).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Right adrenal gland is incompletely imaged but has a bulky appearance which is nonspecific and may be further evaluated with dedicated adrenal CT or MRI if clinically indicated.
1. Bulky mediastinal lymphadenopathy and right hilar mass with adjacent interstitial and airspace disease concerning for primary neoplasm with local extension and lymphangitic spread.2. Bulky right adrenal gland as described above.