Primary lung tumours in children are rare and metastatic lung disease is uncommon. The majority of children who present with a primary or secondary pulmonary malignancy will present co-incidentally while seeking attention for another medical problem, or with non-specific abnormalities such as cough with collapse or consolidation on the chest radiograph. With improved techniques of medical imaging for diagnostic and therapeutic purposes and improved outcomes of childhood malignancies, the role of the respiratory paediatrician in the ongoing care of oncology patients is likely to increase.