evaluation of a tumour of the heart. Fourteen days previously he had been admitted to another hospital with acute pneumonia and then transferred to the University Hospital. At that time a chest x-ray film also showed a bulge at the left inferior border of the cardiac silhouette.On admission he was asymptomatic. He referred to occasional bouts of palpitation and dyspnoea on exertion in the recent past. On physical examination the blood pressure was 110/75 mmHg (14-6/10 kPa); the radial pulse was regular and 80/min, and the body temperature 36 8°C. The neck veins were distended 2 cm above the supraclavicular fossa when the patient was reclining at 450, and there was a prominent a wave in the jugular pulse. The cardiac apical impulse was palpable at the 5th left intercostal space over the midclavicular line. There was a loud third heart sound, a fourth heart sound, and a grade 3/6 diastolic murmur, louder in middiastole, increasing on inspiration, and audible at the apex of the heart. Some crepitant rales were present at the right lung base, and a slightly tender liver was palpable 8 cm below the xyphoid process and 6 cm below the right costal margin.Laboratory data included a haemoglobin concentration of 11-7 g/dl, serum protein of 62 g/l (albumin 30 and globulin 32 g/l), and a negative tuberculin test with an original tuberculin concentration of 1:10-000.