A 38-year-old man presented with a history of influenza-like symptoms and a persistent dry cough. He had been previously fit and well, other than a road traffic collision 20 years ago, in which he sustained bilateral pneumothoraces, left hemidiaphragm injury with herniation of the stomach into the left hemithorax and splenic injury. He therefore had undergone an emergency laparotomy, splenectomy and repair of the left hemidiaphragm. He was a non-smoker and denied contact with TB or asbestos. Physical examination was unremarkable other than a laparotomy scar.

Chest radiograph showed a large opacity behind the cardiac silhouette suspicious for primary lung cancer (figure 1A). CT of the thorax and abdomen confirmed a 41 mm soft tissue mass in the left lower …