Lung cancer is a major problem facing Australian doctors representing 9% of all cancer diagnoses and with 12,200 new cases of lung cancer diagnosed each year it is the fifth most commonly diagnosed cancer, but the most common cause of cancer death in this country for both men and for women. The early presentation of lung cancer may be as subtle as a small coin lesion or nodule seen on chest imaging and there are a multitude of ways in which such nodules may be interrogated further. Whilst a wait and watch approach may be appropriate, further evaluation by VATS with a tissue diagnosis maybe required.