A 60-year-old male presents to his primary care physician with reports of experiencing fatigue, dyspnea, cough, dysphagia, and occasional hemoptysis, which have persisted and increased in severity for the past 2 months. He also reports a 12-lb unintentional weight loss during this time. The patient is an electrician and has been married for 35 years. He has been a one-pack-per-day smoker for the past 40 years. He has a history of hypertension and high cholesterol, both of which are managed pharmacologically. Otherwise, his medical history is unremarkable.

Physical exam reveals hoarseness and wheezing. Flaring of the nasal alae and use of accessory muscles are visible during respiration. Dullness to (chest) percussion and decreased breath sounds are present on auscultation as well as heart sounds that are distant. Pleural effusion is suspected. Jugular venous pulsation is elevated and rises on inspiration. There is slight edema of the extremities and ipsilateral supraclavicular lymph nodes are enlarged.

Routine laboratory tests are performed, and results show:

• complete blood count w/diff: no presence of anemia or cytopenia; hemoglobin = 12 g/dL; platelets = 200,000 µL; absolute neutrophil count = 5000 µL
• Serum electrolytes: normal
• Renal function: normal
• Liver function tests: slightly elevated but within normal range
• Alkaline phosphatase: normal
• Lactate dehydrogenase: elevated
• Calcium: normal