56 year old chronic smoker, known case of COPD complaining of chest pain with hemoptysis. CT revealed spiculated nodule in the left upper lobe with right para tracheal lymph node at paraceptal and centricinar emphysema.

Patient referred for CT guided biopsy. The lesion was found to be under a rib. Lesion was accessed with orbital and cranial angulations.

HPE: Adenocarcinoma