Right sided pleuritic pain.
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Irregular opacity in the left apex. Bony erosion of the lateral first rib. Multiple nodular opacities noted throughout both lungs.
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Irregular or spiculated opacities are always concerning for malignancy, the key in this case is the presence of bony erosion, which is indicative a more aggressive process. CT (not shown) confirmed left apical tumour (histology not available as patient transferred).