Metastatic pulmonary small cell carcinoma (SCC) with left upper lobe collapse

There is dense opacification of the left hemithorax, with elevation of the hemidiaphragm consistent with loss of volume. On the lateral projection there is anterosuperior opacity, suggesting collapse of the upper lobe. In addition there is the impression of increased soft tissue at the left hilum, however this is not well assessed. The right lung is clear. No osseous lesion is identified. The concern is for an obstructing left hilar lesion, specifically bronchial carcinoma. Further investigation with CT is recommended.

Contrast opacification of the pulmonary arteries is non diagnostic. A pulmonary embolism cannot be excluded on this study.

There is collapse of the left upper lobe without demonstration of air bronchograms, consistent with obstruction due to an endobronchial lesion (in the left upper lobe bronchus), although a separate/discrete lesion is not identified.There is associated mediastinal lymph node enlargement particularly in the left lower paratracheal and prevascular groups.  The largest lymph node is preaortic measuring 34 x 33 mm.

In association is a left moderately sized, likely malignant, pleural effusion.  There is positive mass effect with shift of the mediastinum towards the right.  The left lower lobe demonstrates patchy areas of non-specific ground glass change. Two 7 mm nodules are demonstrated in the right lower lobe in the posterior and medial basal segments.  A mosaic pattern of attenuation in the right lung is indicative of underlying chronic small airways disease.

A 13 mm sclerotic lesion in the lateral 6th rib is noted. No other suspicious bony lesions identified.  Innumerable hypodense liver lesions are demonstrated.

There is a 14 mm nodule in the right adrenal, of relatively low density (24HU). A right thyroid nodule measures 38 x 27 x 80 mm.  Further investigation with ultrasound if clinically appropriate.

Conclusion

1. Non-diagnostic CTPA. PE cannot be excluded.
2. Likely left upper lobe endobronchial lesion with obstructive collapse of the left upper lobe and malignant left pleural effusion.  Associated mediastinal lymph node enlargement.
3. Metastatic disease demonstrated in the right lung (lower lobe), left 6th rib, liver and right adrenal. 
4. Thyroid nodule of uncertain significance with further ultrasound investigation if clinically appropriate.