L.E., a 68-year-old man, was admitted to the pulmonary unit with chest pain on inspiration, dyspnea, and diaphoresis. He had smoked 11?2 packs of cigarettes per day for 52 years and had quit 3 months ago. L.E. was retired from the advertising industry and admitted to occasional alcohol use. He was treated for primary giant cell sarcoma of the left lung 3 years ago with a lobectomy of the left lung followed by radiation and chemotherapy.

Physical examination was unremarkable except for a thoracotomy scar in the left hemithorax, decreased breath sounds, and dullness to percussion of the left base. There was no hemoptysis. Radio-nucleotide bone scan showed increased activity in the left upper posterior hemithorax. Chest and upper abdomen CT scan showed ?ndings compatible with recurrent sarcoma of the left hemithorax. Abnormal mediastinal nodes were evident. Thoracentesis was attempted but did not yield fluid. L.E. was scheduled for a left thoracoscopy, mediastinoscopy, and biopsy.

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