Findings:
There is a spiculated 24 x 15 mm nodule in the right lung apex. There if also a 3 mm nodule in the periphery of the right upper lobe. There is mild to moderate centrilobular emphysema, mild dependent atelectasis, and trace bilateral pleural fluid. There is a large 45 x 40mm conglomerate bulky lymphadenopathy that completely encases and completely occludes the superior SVC. This occlusion results in superficial collaterals emptying into the IVC and azygous system.

Impression:
There is evidence of right upper lobe primary lung malignancy with associated large right mediastinal bulky lymphadenopathy consistent with metastatic disease. The bulky lymphadenopathy encases and completely occludes the upper SVC. The superficial collaterals emptying into the IVC and azygous system, the “hot quadrate sign,” and extensive upper body soft tissue swelling are consistent with the SVC syndrome.

Recommendations:
For your training purposes, recommendations are not included in this report.