Thompson et al. Journal of Medical Case Reports 2010, 4:17 http://www.jmedicalcasereports.com/content/4/1/17 Page 2 of 4 Figure 1 Chest X-ray showing a small right basal pleural reaction and some right basal atelectasis. immediately posterior to the hilum and occluding the lower lobe bronchus (Figure 2). LMWH was discontinued and an urgent flexible bronchoscopy was performed 24 hours later. The view was obscured by active bleeding, and although a large tumour was seen in the right lower lobe bronchus it was not possible to undertake a biopsy. The woman was therefore discharged home and readmitted within the week for a scheduled rigid bronchoscopy. Biopsy was performed and unfortunately histopathology indicated a probable well-differentiated fetal adenocarcinoma. Subsequent management was discussed in a Multidisci- plinary Team Meeting, involving obstetrician, respiratory physician, cardiothoracic surgeon, radiologist and histo- pathologist. The possibility that there may be blastamous foci was raised. The need for appropriate staging, includ- ing abdominal computed tomography (CT) and positron emission tomography (PET) scan, with right pnuemo- nectomy should the tumour be localised, was agreed. As the safe use of PET in pregnancy has yet to be evaluated, it was decided that the baby should be delivered first. Given that the woman was then 31+ 4 weeks gestation it was decided that she should receive corticosteroids over the following 48 hours (betamethasone 12 mg IM 24 hours apart), so as to encourage fetal lung matura- tion, with a view to delivery during 32 weeks of gesta- tion. As there were some concerns as to whether Valsalva during second stage (that is active pushing) might precipitate significant haemoptysis from an appar- ently vascular tumour, an elective caesarean section was considered. However, following discussions with the woman, who was very keen to avoid such surgery, it was agreed that an induction should be attempted. Fortu- nately, following two does of prostaglandin, an amniot- omy was possible. After that, she went on to deliver a male infant weighing 1970 gm. Four days following delivery, a PET scan suggested that the tumour within the right bronchus was confined to the right lower and middle lobes of the lung. Within ten days of delivery she was admitted for right lower and middle lobectomy. Several large sub-carinal glands were also removed. Surgery went well without