Chest X-ray: what feature is of most concern?

The most obvious feature is probably the bilateral calcified pleural plaques, which are benign and consistent with previous asbestos exposure. However, the feature warranting most concern is the loss of the gastric air bubble. This 72-year-old man presented with a non-specific general deterioration in health. He subsequently underwent computed tomography scanning of his thorax and abdomen, which not only demonstrated the calcified pleural plaques, with no evidence of parenchymal disease, but also showed an enhancing soft tissue mass along the lesser curvature of the stomach extending towards the fundus, consistent with a gastric tumour.