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A 74-year-old man presented with dyspnoea and reduced exercise tolerance (Medical Research Council grade 4). He was a current smoker with a history of paroxysmal atrial fibrillation and COPD for which he was on bronchodilators. There was no history of previous chest trauma or surgery and physical examination was unremarkable. CT thorax showed a 3.2 cm mass in the anterior mediastinum with two foci of coarse calcification (figure 1A). Positron emission tomography (PET)/CT demonstrated significant uptake (maximum standardised uptake ratio of 13.7) in the mass with a central area of inactivity (figure 1B); there was no significant activity elsewhere. His gas transfer was reduced at 63% predicted.
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