To the Editor:—
The appearance of the lesions in the roentgenograms was so characteristic for pulmonary metastases (rounded and sharply limited, almost homogeneous, large in size and few in number, and growing rapidly in a patient who lost much weight in a short time) that they were read as metastatic in nature even before the primary tumor was found. When a nephrectomy was performed and an adenocarcinoma was found, the diagnosis of metastases became definite. Many statements appear in the literature about the value of roentgenograms in the diagnosis of pulmonary metastases. Rigler, in "Outline of Roentgen Diagnosis" (Philadelphia, J. B. Lippincott Company, 1954, p. 93), wrote that in almost all cases the diagnosis of pulmonary metastases can be definitely made by this means alone, as the lesions, even in their early stages, are very characteristic. In "The Chest and the Heart" (edited by Myers and McKinlay, Springfield, Ill., Charles