A typical case was discussed at the morning meeting today, and the purpose was to give a reasonable treatment plan for this patient. After the meeting, I experienced the plan carefully, and each step was well justified, which was very worth learning. As a surgeon, it is very important to be able to develop a reasonable and effective treatment plan for each different patient. The patient, male, 75 years old, was admitted to the hospital with “cough and sputum with fever for more than a month”. A month ago, he “caught a cold” after exertion, followed by recurrent cough and white sputum with intermittent low fever, without chest tightness and fatigue. He was admitted to our hospital for further diagnosis and treatment after anti-inflammatory and symptomatic treatment. Past history: He had a history of severe left-sided chest trauma 30 years ago. Physical examination: normal vital signs, solid percussion sounds in the left lung. Chest CT: (see excerpted CT images for details) right hilar mass, size about 3.0×3.5 cm, pulmonary artery, upper pulmonary vein, and upper lobe bronchus were not involved, the mass encircled the middle segment bronchus, huge old encapsulated effusion in the left thoracic cavity, severe compression of the upper and lower lobes of the left lung, scattered patchy shadow in both lungs, and multiple old rib fractures on the left side. Mediastinal lymph nodes were scattered and enlarged, none of them exceeded 1 cm; pulmonary function: EEV1:1.2; left thoracic parcel puncture: a small amount of coffee-colored material was punctured, considering old blood accumulation parcel. II. Discussion of the results: Treatment options: ① Consider the possibility of malignant occupancy in the right hilar mass, and consider the left side as a mechanized parcel of accumulated blood after chest trauma. ② Perform e-bus guided puncture for pathological examination of the right lung mass to clarify its histological type. ③ Two cycles of neoadjuvant chemotherapy were given according to the histological type. ④ At an interval of two weeks, a left-sided encapsulated effusion removal was performed. ⑤ Two weeks after surgery, the left side incision was healed, and then the right side middle and lower lung lobectomy + mediastinal lymph node dissection was performed. The rationale for the protocol: ① With the continuous improvement of thoracic surgical techniques and the continuous upgrading of hardware facilities, senior patients are no longer an absolute contraindication to surgery, and patients who meet the indications for surgery should be actively treated surgically. Because surgery is still the only means to cure lung cancer at present. ②The patient’s left lung is severely compressed and the lung function is poor. If the right middle and lower lung lobectomy is rashly performed at this time, the residual lung function cannot meet the needs of the organism after surgery, so the left lung should be cleared of encapsulated fluid to reopen the left lung first. (③) Lung cancer surgery is a deadline surgery, and we cannot wait for a long time. Therefore, e-bus guided puncture of the right lung mass for pathological examination can be performed first to clarify its histological type and neoadjuvant chemotherapy can be administered. ④ Neo-adjuvant chemotherapy may make the tumor down-stage, and the lung function is expected to be improved to different degrees after the left lung resuscitation, and then it is more appropriate to perform radical lung cancer treatment.