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A 63-year-old woman was referred to the lung cancer clinic after presenting to the emergency department with a 10-day history of fever, chest tightness and breathlessness. Chest X-ray showed a left-sided retrocardiac mass, and an urgent CT scan was requested. On review, she reported a 2-month history of intermittent cough and night sweats. She denied weight loss or haemoptysis. She was an ex-smoker. Her medical history included two episodes of pneumonia in the 1980s. There was no history of recurrent childhood infections or exposure to tuberculosis. Performance status was zero and she worked for the NHS as an operating department practitioner. CT scan demonstrated a left lower lobe mass suspicious for malignancy. Preliminary radiological staging was T4N0M0 (figure 1). Figure 1 Axial CT image showing left lower lobe mass. On positron emission …