CT of chest, abdomen, and pelvis. The purple arrow shows innumerable pulmonary masses and lymphangitic carcinomatosis in bilateral lungs with focal areas of hypoattenuation consistent with necrosis and mediastinal and bilateral hilar lymphadenopathy with mass effect on multiple bronchi. This is consistent with the patient's biopsy-proven metastatic adenocarcinoma. The red arrow shows bilateral pleural effusions and compressive atelectasis of the right lower lobe.