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April 30, 1955


Author Affiliations

Portland, Ore.; Los Angeles

Attending Consultant in Thoracic Surgery, Veterans Administration Hospital (Dr. Higginson); formerly Resident in Surgery, Veterans Administration Hospital, Portland, Ore., and now Instructor in Surgery, College of Medical Evangelists (Dr. Hinshaw).

JAMA. 1955;157(18):1607-1609. doi:10.1001/jama.1955.02950350021009

The problem of the asymptomatic, solitary, coin-shaped, pulmonary lesion was first fully presented by O'Brien and others,1 who studied 21 patients in whom coin-shaped pulmonary roentgenographic shadows were seen on routine or survey chest roentgenograms. In all instances an exact diagnosis was impossible by clinical methods. Since an appreciable number of the lesions were probably serious in nature, an exploratory thoracotomy was performed on each patient in order to establish a histological diagnosis. Eight, or 38%, of the 21 patients had bronchogenic carcinoma, and the others had tuberculomas or other nonmalignant lesions. The natural conclusion of their study was that all such solitary, benign-appearing, pulmonary lesions should be treated by exploratory thoracotomy rather than by a long period of observation. Subsequent studies of solitary lung lesions by other investigators2 show considerable differences in the selection of cases and in the types of lesions found at surgery. The percentage

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