Contrast enhanced CT of the chest of a 64 years old male smoker with a large mass (asterisk) in the apical portion of the right lung shows absence of contrast in the right brachiocephalic vein (white arrow) suggesting tumor thrombus. Other vessels are well opacified. Mass destroys right side of the vertebral body and adjacent rib and extends into the spinal canal (double black arrows). Dilated hemi-azygous vein (oval arrow) is noted along the left side of the mediastinum suggesting collateral flow