Paroxysmal cardiac arrest. Report of a case with simultaneous atrio-ventricular standstill presumably due to carcinoma of the lung and responding to radiation therapy.

A 37-year-old, married, white, machine tool inspector entered the White River Junction Veterans Administration Hospital on October 22, 1959 because of an abnormal routine chest x-ray film finding. H e had no complaint. Eight years prior to admission, while in the Navy, at age 29, a spontaneous left-sided pneumothorax was treated by poudrage. His mother and brother were thought to have had tuberculosis at one time. Accordingly, he had been x-rayed every three months by the Vermont Health Department. His last x-ray film prior to admission showed a large left hilar mass which was not present three months previously. He had smoked one and onehalf packs of cigarettes a day since age 14. He denied any symptom whatsoever, and his initial physical examination was unremarkable. One of three sputum samples showed positive cytologic evidence of malignancy. Eight prescalene lymph nodes showed no evidence of tumor. Bronchoscopic examination showed some fixation of the left tracheobronchial angle, but the orifices appeared normal. Thoracotomy disclosed massive tumor involvement of the left hilum with multiple pleural and pulmonary metastases-biopsy of which showed undifferentiated carcinoma of large-cell type. Resection was impossible. Postoperatively, he received nitrogen mustard treatment and was sent home on November 25, 1959, still with essentially no symptom. A month later, a mass was palpable in the left supraclavicular fossa. At about this time, he