These occur in about 8 per cent, of all cases, and are chiefly met with in the lower lobes. In most instances they develop at a late stage of the disease, and are usually, though not always, associated with multiple growths of the liver. The special symptoms which are supposed to ensue from the pulmonary affection are pain in the chest, dyspnoea, cough, expectoration, and haemoptysis (Darolles), while examination of the chest reveals dulness on percussion, bronchial breathing, and crepitation. As a matter of fact, however, the pulmonary condition is so often associated with a pleural effusion that its existence is usually merely a matter of surmise.
Carcinoma of the Pleura is frequently associated with disease of the peritoneum, and is also apt to occur from infection of the mediastinal glands or the lung. Pleurisy on the left side is often observed along with growths of the cardia, especially when the disease has extended into the oesophagus, and in such cases a haemorrhagic effusion is sometimes encountered. Perforation of the oesophagus may be followed by pyopneumothorax or gangrene of the lung. Blood-stained fluid in the right pleura is usually associated with disease of the liver or of the lung.