Adenocarcinoma of the lung presenting as a solitary pulmonary nodule

In the authors' hospital, the ratio of primary adenocarcinoma of the lung to metastatic adenocarcinoma in thoracotomy specimens which have been removed from patients who present with a solitary lung mass and without a history of previous malignancy is 10 to 1. The routine use of a preoperative gastrointestinal series, barium enema and intravenous pyelogram in the work up of the patient with a solitary pulmonary mass is usually unproductive. This low yield should be kept in mind in the management of these patients. Contrariwise, the value of a post thoracotomy survey when the question of primary versus metastatic lesion cannot be settled by microscopic study must be appreciated.