35 year-old female with new diagnosis of malignancy of unknown origin presenting with dyspnea and tachycardia. Abdominal mass on palpation. Evaluate for PE and neoplasm. PULMONARY ARTERIES: Technically adequate pulmonary embolus examination without evidence of filling defect to indicate pulmonary embolus.LUNGS AND PLEURA: Left-sided pleural effusion with adjacent compressive atelectasis. Scattered bilateral micronodules too numerous to count.MEDIASTINUM AND HILA: Left upper lobe round soft tissue density mass measures 2.1 x 2.1 cm (image 59/159) series 9, within the left perihilar region region demonstrates mass effect on the left mainstem bronchus and left segmental pulmonary artery.CHEST WALL: Scattered, nonspecific axillary lymph nodes. Destructive lesions of third and fifth anterior ribs. Destructive lesions involve the scapula bilaterally. Multiple lytic lesions throughout the thoraco- lumbar spine consistent with metastatic disease. Expansile lytic lesion within the vertebral body T7 demonstrates posterior expansion into the central canal and may be further evaluated with MRI as clinically warranted.UPPER ABDOMEN: Ill-defined hypodense lesion within the left lobe of the liver with correlated with abdomen and pelvis CT performed same day consistent with metastatic lesion. Multiple retroperitoneal lymph nodes.For further evaluation of the abdomen and pelvis please see dedicated abdomen and pelvis CT report performed same day.
1. No evidence of pulmonary embolus as clinically questioned.2. Left-sided large pleural effusion.3. Multiple scattered micronodules likely represent lymphangitic spread.4. Left parahilar mass causes mild adjacent compression of the left segmental pulmonary artery and left bronchus.5. Multiple bony and hepatic metastases as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.