A 60 year old smoker presents with right shoulder pain that radiates up his neck and down the ipsilateral arm. He complains of dyspnea, non-productive cough, and facial swelling (worse when he bends forward or lies down). Here's another picture:
Here is a CXR of a similar patient (not the same because the finding is on a opposite side).
Challenge: This case has so many random syndromes, it seems almost artificial; it'd be such a good teaching case, you think. What's the final diagnosis? (Be specific - it's named after a Quaker who was, according to Wikipedia, the first professor of radiology).
1. What's seen on the first image?
2. What's seen on the second image?
3. What's seen on the CXR?
4. Why the shoulder pain?
Images are all shown under fair use.