THIS small group of cases seemed to be worthy of publication partly because they illustrate the expanding scope of thoracic surgery which, as each year passes, brings new problems for solution, and partly because the lesions themselves may properly be described as unusual.Two are examples of pathological lesions which occurred in the pre-pericardial pad of fat. This structure has received but scant recognition from the anatomists, and its existence is not mentioned in the standard text-books. It is, nevertheless, the seat of disease upon occasion, and several interesting papers recently published in American journals have testified to this fact.One case is that of a teratoma of the lung.We are aware of the difficulties of finally assessing the exact nature of many of the pathological processes in this organ, but, in this instance, the definite mixture of carcinomatous and sarcomatous elements leaves but little doubt of the diagnosis.T w o patients suffering from adenoma of the bronchus are included. This condition is now well recognized, but many points pertaining to the clinical features and to the wisest methods of treatment are still sub judice, and it is for this reason that the cases are presented.
PREPERICARDIAL CYSTCase I.-Mr.H. M., aged 36, was admitted to St. Thomas's Hospital in March, 1943. He had noticed increasing dyspncea on exertion over a period of six months. By profession he was a shot-blaster, and it had been assumed that the shortness of breath might have been due to his trafe. He also complained of intermittent ' pressure behind the lower end of the sternum, but there was nothing to suggest pain of the anginal type.Physical examination was negative in all respects and the patient appeared to be in excellent health; but radiographs of the chest revealed an opacity, about the size of an orange, situated in the right chest and lying in the angle between the right border of the heart and the dome of the diaphragm (Figs. 380, 381). The mass lay in the extreme front of the chest, immediately behind the sternum.The patient had an occasional cough and some mucoid sputum ; the latter contained neither significant organisms nor malignant cells. The temperature, pulse, and respiratory rates were normal; the blood-pressure was 140/9o mm. of mercury and the Wassermann and Kahn reactions were negative. The bronchial tree was shown to be normal by bronchoscopy and bronchograms, and the diaphragm was not paralysed. The electrocardiograph was normal, and the possibility of a diaphragmatic hernia (through the foramen of the internal mammary
