A 50-year-old man, chronic smoker, smoking 20 cigarettes per day for the last 30 years, presents to the pulmonary out-patient department with complaints of right-sided chest pain accompanied by tenderness over the right chest wall and occasional hemoptysis, since the past 4 months. The chest pain disturbs his sleep and he now requires increasing doses of pain killers in order to combat the pain. He has lost 20 kgs weight over the last 4 months.
On examination, the right hemithorax is significantly tender on palpation, and moves less with respiration as compared to the left side. A swelling is noticed in the right supraclavicular region which is hard, non-tender and fixed to the underlying structures.