Unusual manifestations of carcinoma of the lung.

cinoma for surgical treatment the physician must satisfy himself that the patient has sufficient pulmonary reserve and cardiac vascular reserve to withstand pneumonectomy should that be necessary. He must be certain there are no metastases. He must satisfy himself that the phrenic nerves, the sympathetic nerves, and the recurrent laryngeal nerves are not involved. He must, by examining the barium swallow, be certain that mediastinal glands are not involved by growth, and he must satisfy himself that the great veins in the thorax are not compressed or invaded. At the same time he must realize that even a pleural effusion or involvement of a phrenic nerve do not inevitably signify that the growth is irremovable. Surgical excision is often the best prospect of cure and no patient should be considered to be beyond surgical aid without most careful deliberation. Furthermore exploratory thoracotomy is without serious consequence if the tumour is irremovable. It has recently been suggested that angiopneumography (Weiss et al., 195I) is an essential preoperative investigation in order to determine prospects of surgical removal. While this may be true in some centres such studies elsewhere will continue to take second place to surgical exploration.