An 81-year-old man underwent a routine chest x-ray examination (fig 1) before cystoscopy performed to investigate painless haematuria; he was otherwise well. This showed a 10 cm lobulated mass adjacent to the right heart border. Also noted were midline sternotomy wires from coronary artery bypass graft (CABG) surgery performed 23 years previously. He was a non-smoker and had no other significant medical history. Cystoscopy revealed carcinoma in situ, which was effectively treated with electrocautery, and he was subsequently referred to …