Patient recently had a cardiac catheterization which did not show any significant coronary artery disease. There is an abnormal fat collection at the right lung apex that seems to engulf the right subclavian vein and either expands the right brachiocephalic vein or compresses and flattens it. Extensive collaterals are noted around the right shoulder and posterior chest wall with dense opacification of the azygous vein. However, the superior vena cava is patent. There is no evidence of aortic dissection.
Aortic size is within normal limits.
There is minimal bilateral pleural thickening. Some pleural-based small pulmonary opacities are noted in both lung bases which probably represent either areas of atelectasis or air space opacity. These opacities were not present in a previous chest x-ray.