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Fig. 4A. —Solution to problem of access to posterior right lung tumor in 60-year-old woman with metastatic cystosarcoma shielded by overlying rib. Prone CT scan displays tumor adjacent to thoracic vertebra and mediastinum. Note overlying rib and transverse process (arrows) of thoracic vertebra. Lateral approach was not used to reduce likelihood of pneumothorax in this patient with emphysema. T = tumor.