An 18-year-old woman presented initially in 1980 with mild shortness of breath and a chest X-ray showing right lower lobe collapse. Bronchoscopy at this time showed narrowing of the orifice to the lower lobe with a normal mucosal appearance. She was then lost to follow-up until 1988 when she re-presented with a cough productive of purulent sputum and worsening episodes of haemoptysis. During the intervening years, mild shortness of breath and haemoptysis had persisted. Chest X-ray (Plate 1) again showed right lower lobe collapse and also a large mass in the mid-zone. CT (Plate 2) confirmed a large, lobulated mass arising from the apical segment of the lower lobe. Repeat bronchoscopy showed external compression of the right bronchi almost to the carina. Pulmonary function testing was only 60% of predicted. At exploratory thoracotomy, a large, hard, intrapulmonary tumour was found occupying the right paravertebral gutter and invading the chest wall, diaphragm, mediastinum and pericardium around the inferior pulmonary vein. Frozen section was unhelpful. The mass was excised with difficulty by a pneumonectomy plus excision of the central part of the right hemidiaphragm and part of the left atrium. She made a good postoperative recovery and was discharged in February 1989. In the first postoperative year, she claimed mild continuing haemoptysis. CT