The patient, a 77-year-old male, presented to a hospital in Guangzhou in early June 2013 with “coughing and coughing white mucus sputum with blood in the sputum for one month and swelling of the head, neck and both upper limbs for one week”. Past history: cholecystectomy and hepatic artery ligation 20 years ago Personal history: smoker for more than 50 years, 1 pack per day, no history of alcohol abuse. Physical examination: swelling of the head, face, neck and both upper limbs, coarse breath sounds in both upper lungs, turbid percussion sounds in the right upper lung, no dry and wet woven grasses in both lungs. Bronchoscopy: endobronchial lesions were seen in the right upper lung lobe, and poorly differentiated cancer cells were seen in the smear, which was considered small cell carcinoma. PET/CT examination was performed in the hospital on June 7, 2013, which showed that: 1. multiple nodules in the right hilar region and right lower lung were metabolically active, considering malignant lesions, the lesions blocked the right middle lung bronchus, and right middle lung atelectasis; 2. mediastinum and right lung lymph nodes were metabolically active, considering metastasis; 3. right pleural effusion.