Spontaneous pneumothorax due to metastatic carcinoma of the rectum.

one episode of haemoptysis. Ten years previously he had undergone an abdominoperineal resection for a Duke's C adenocarcinoma of the rectum. A spontaneous pneumothorax was diagnosed and confirmed by a chest radiograph which also suggested a left hilar abnormality (figure). The pneumothorax was managed by intercostal chest drainage but the lung failed to re-expand. Bronchoscopy showed a tumour in the left main bronchus close to its bifurcation. Biopsy of this lesion revealed a poorly differentiated adenocarcinoma. Other investigations showed no contraindication to resection. At operation the left lung was found to be totally collapsed with a 4 x 5 cm tumour in the lower lobe, infiltrating close to the visceral pleura at the base. As the tumour extended