-year-old man who was a heavy smoker was referred for investigation of
voice hoarseness. Physical examination disclosed a left-sided hard
supraclavicular lymph node. The initial chest radiograph is shown in
. Fiberoptic bronchoscopy showed a paralyzed left vocal cord and
stenosis of the left upper lobar bronchus; endobronchial biopsies were
obtained. The lymph node was separately excised under local anesthesia.