A 60‐year‐old man presents to A&E feeling very short of breath. He says that his breathing is worse on lying flat and his family have commented that his face and neck look swollen. Over the last few days his headache has got worse especially when he coughs. He states that the only medical problem he has is a cough which he has attributed to a smoker's cough but he describes haemoptysis is the last month. He does not take any regular medications. On examination he looks plethoric, his face appears swollen and he has dilated veins over his chest wall. His BP is 100/50 mmHg with a pulse rate of 110 beats/min. His oxygen saturations are 92% on room air. Please look at the chest X‐ray below (Fig. 0003).

Fig. 0003.