A 74 year old female, with a h/o hypertension and type II diabetes, presents for evaluation of chronic cough and worsening dyspnea. She reports a 60 pack year h/o cigarette use. Physical examination was normal except for a 2 cm firm right sided supraclavicular lymph node and a focal wheeze in the right upper lung field anteriorally. Chest x-ray reveals a 4 cm right sided supra-hilar mass, possible narrowing of the right upper lobe bronchus, and probable hilar, sub-carinal, and mediastinal lymphadenopathy which was confirmed by CT scanning.