A 66-year-old Nepalese man with a medical history of hypertension presented with a 4-month history of an intermittently productive cough, worsening breathlessness, unintentional weight loss and a progressively enlarging lump on the right anterior chest wall that had become red and warm in the days prior to admission. On examination, he was cachectic, febrile and tachycardic, but the chest was clear on auscultation and there was no oxygen requirement. A 16 cm tender, erythematous and warm lump was evident on the right anterolateral chest wall. Initial bloods demonstrated normocytic anaemia, neutrophilia, thrombocytosis, hypoalbuminaemia and serum C reactive protein of 208 (range 0–5 mg/L). Chest radiograph demonstrated right middle and lower zone opacities (figure 1A). CT of the chest revealed multiple ‘nodules and masses in the right hemithorax’ and was reported as a ‘widespread primary lung malignancy’ with a provisional …