45 yr old presents with a 2.4 cm left upper lobe mass. He has a 25 year history of smoking two packs of cigarettes a day. Physical exam is unremarkable aside from a 2 cm palpable left supraclavicular lymph node. CT of the chest reveals ipsilateral mediastinal lymphadenopathy and enlargement of the left supraclavicular lymph nodes. Biopsy of the supraclavicular lymph node reveals moderately differentiated adenocarcinoma.
PFTs do not preclude resection. MRI of the brain is negative. Bronchoscopy does not detect an endobronchial lesion.