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Three patients are reported who exhibited a previously undescribed syndrome resulting from disruption of the sympathetic chain, the phrenic nerve and the innervation of the ipsilateral vocal cord. Each patient had pain in the ipsilateral shoulder and metastatic carcinoma of the breast. It is likely that this syndrome exists in association with other diseases such as carcinoma of the lung. The presence of this syndrome in patients with malignant disease has sinister significance and appears to carry a very grave prognosis.