This case is a classic illustrating the huge importance of checking the review areas on a chest x-ray.

This includes the retrocardiac space - when shown or indicated this tumor (lung cancer) is very visible, but easily overlooked by the unaware of if under time pressure.

The film could be used either in an FRCR 2B rapid reporting set or as the start for a viva case moving to CT Chest and subsequent management questions.

Discussion may include:

1.  How one would handle the x-ray of a primary care referral

2.  Recommendation - urgent referall to lung cancer MDT

3. Identifying the radiological stage

4. The role/amenability of CT guided lung biopsy