Acute pulmonary embolus in the main pulmonary artery extending into the right main pulmonary artery with additional emboli in the right lobar/upper segmental and left upper segmental arterial branches. No right heart strain or pulmonary infarct. Small bilateral pleural effusions with subjacent atelectasis. Widespread pulmonary metastases. Extensive mediastinal and supraclavicular lymphadenopathy.