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Previously seen right hilar / upper lobe mass extending inferiorly into the right middle lobe and right lower lobe appears considerably larger than on the previous study but is difficult to separate from more peripheral pneumonitis. It measures approximately 5.8 x 4 cm, previously 3.7 x 2.8 cm. The more inferior nodular component is also surrounded by pneumonitis and is difficult to measure but it likely larger. There is encasement of bronchus intermedius and right middle lobe bronchus which is obstructed.

Previously seen innumerable tiny nodules in both lungs have increased in number and are mostly new in the left lower lobe and dominant nodules seen previously have increased in size.
Several right upper paratracheal nodes have increased in size the largest measuring 1.2 and 1.4 cm. Subcarinal adenopathy similar or slightly larger.
A right supraclavicular node measures 1.7 x 0.8 cm and has enlarged since the previous study.

The previously seen low density lesion adjacent to the falciform ligament is less apparent than on April 30 with no other focal hepatic lesions seen. The spleen, pancreas, adrenals and both kidneys appear normal apart from a simple right lower pole renal cyst. No free fluid.

Previously seen mixed lytic and sclerotic metastases in the spine and also in the proximal femurs are not significantly changed.


Considerable enlargement of right lung mass and adjacent obstructive pneumonitis. Stable right pleural disease. Marked progression of micronodular disease throughout both lungs. Differential diagnosis includes progressive metastatic lung disease and superimposed infection including fungal infection or TB.

Mild progression of mediastinal and right supraclavicular adenopathy.

Hepatic lesion is less well-seen.

Regarding the brain, a small subcortical low density in the medial left parietal lobe is of uncertain etiology. It is not typical of a metastasis or neoplasm. Subcortical ischemic disease would be unusual for this age.