There is a large mass in the right upper hemithorax peripherally. This is closely related to the superior aspect of the right oblique fissure, and is felt most likely pleural in origin. It has a smooth, gently lobulated margin, and is centrally heterogeneous with internal hypodense areas. No internal calcification. There is no erosion or destruction of the overlying ribs and no obvious invasion of the extrapleural fat.
Two smaller pleural nodules are seen above the mass, measuring 6 mm and 5 mm in size respectively. No pleural fluid collection. There is some subtle nodularity of the left-sided pleura anteriorly. The lungs are clear. No pneumothorax.
Left and right coronary artery calcification. Borderline enlarged aortopulmonary window lymph node measuring 10 mm in short axis. Elsewhere there are no enlarged hilar or mediastinal lymph nodes.
Multiple hypodense liver lesions compatible with cysts.
Conclusion:
The large mass in the right upper thorax favoured pleural. A pleural neoplasm is most likely, with differentials including fibrous tumour and metastasis. Mesothelioma is felt less likely. A primary lung lesion extending into the pleural is also less likely, though
is not excluded.
Respiratory referral and discussion at the multidisciplinary meeting are advised, as is a further assessment with PET and consideration of biopsy.