A 51 year old man had smoked 50 cigarettes per day for 35 years. He had a chronic cough for over 30 years, and increasing shortness of breath on exertion for 2 years. During the 6 months before admission, he had lost 10 kg in weight, and had suffered right-sided chest pain, and a productive cough, coughing up blood (haemoptysis) on one occasion. On examination, there was normal expansion of both lungs, but breath sounds and the percussion note were decreased over the right base. Chest X-ray showed a large, opaque shadow in the right lower zone adjacent to the midline. Bronchoscopy was performed (a fibreoptic telescope was used to explore the bronchi), and a biopsy (tissue sample) showed bronchogenic carcinoma, squamous cell type. At operation, there was an extensive carcinoma of the central portion of the right lung, with mediastinal extension and pneumonic consolidation of the lower lobe, and a pneumonectomy (removal of the lung) was performed.