A 54 year old man was referred by his primary care physician for further evaluation of a 4 month history of progressive swelling over his right scapular region. He had complained of a mildly productive cough for 2 months and a weight loss of 4 kg during the past month. He was a smoker of 35 pack years. Physical examination revealed a painful mass fixed on the right scapular region (fig 1). The rest of the chest examination was normal.