THE marked infrequency of large fibromata of the kidney would appear to justify the recording of the following case. CASE HISTORY.-G. H., a man of 41 years of age, was referred to the outpatient department for investigation about a right-sided abdominal tumour. The patient complained of not being quite fit for a year, and for three months had suffered from ' rheumatism ' around his ribs. He had felt some slight discomfort in the right side of the abdomen for three weeks, and had noticed a swelling in his abdomen while having a bath.
CLINICAL EXAMINATION.-A tense regular swelling the size and shape of a rugby football occupied the right half of the abdomen. It extended from the right costal margin above to immediately above the right inguinal ligament below, and extended for an inch across the midline in the region of the umbilicus. The swelling moved on respiration, and dullness over it was continuous with the liver dullness. Bimanual examination was not definite in determining whether the tumour was renal in origin. It was thought that the swelling might be a tense cyst, possibly in association with the kidney.
CYSTOSCOPY AND PYELOGRAPwf.-These were carried out on Sept. 28, 1936, to confirm or refute the renal origin of the tumour. The bladder was normal on cystoscopy, and a clear efflux was observed from either side. The left pyelogram was normal. The opaque catheter on the right side was displaced across the midline from the region of the first sacral to the level of the second lumbar vertebra, and at the level of the first lumbar vertebra the upper end of the catheter lay in front of a ~p e ~~~~~l ~~~~l ~~~e m ~ ;igrz: the right side of the vertebral body. The the ureter in its abdominal and upper pelvic pmtions is markedly displaced towards the other pyelogram here showed that the kidney was side. The pelvis and calices are somewhat disdisplaced upwards and rotated, with the major torted and elongated, and the entire kidney is displaced upwards and rotated.