This is a PA Chest Xray of 48 years old man who was a heavy Smoker for more than 15 years, came to the hospital complaining of drooping of his Right eye lid and pain and numbness in his right arm for 1 month duration.On Examination he was found to have Right sided Ptosis, Miosis(constriction of the pupils and wasting of the small muscles of the Right arm.Comment on this X ray and What is the most probable Diagnosis in this patient?
ANSWER-Pancoast tumor in the upper part of the right apical region of the Lung
- Pancoast tumors are lung cancers situated at the top of the right or left lung and invade the chest wall
- They are also called superior sulcus tumors.
- Pancoast tumors often come along with unique symptoms collectively known as pancoast syndrome
- Most pancoast tumors are non-small cell lung cancers.
- Growing tumor may compress the brachiocephalic vein, subclavian artery,Superior Vena Cava, phrenic nerve, recurrent laryngeal nerve, vagus nerve, or a sympathetic ganglion.
Symptoms & Signs of a Pancoast Tumor
- Common in Heavy Smokers
- ConstitutionalSymptomsof Cancer - malaise, fever, weight loss and fatigue
- Features ofHorner's Syndrome due to compression of the Sympathetic ganglion
miosis (constriction of the pupils)
anhidrosis (lack of sweating)
ptosis (drooping of the eyelid)
enophthalmos (sunken eyeball)
- Symptoms due to the compression of Brachial Plexus
- Arm and shoulder pain, with pain frequently radiating down the arm
- Weakness & Wasting of hand muscles
- Tingling and prickly sensations in the hand
- If it compresses the recurrent laryngeal nerve - Hoarse voice
- In superior vena cava syndrome- facial swelling, cyanosis and dilatation of the veins of the head and neck
- These tumors are less likely to have typical lung cancer symptoms, such as shortness of breath and coughing
- Pancoast tumors are also difficult to see on chest x-rays due to their location.
- CT scans and MRI are often done
- Biopsy to confirm the diagnosis
Differ from that of other types of non-small cell lung cancer because of its close proximity to other vital structures
Radiotherapy and chemotherapy given prior to surgery (neoadjuvant treatment)
Surgery may consist of the removal of the upper lobe of a lung together with its associated structures
Prognosis of a Pancoast Tumor
Have a better prognosis than tumors that are located more centrally in the lungs
The 5-year survival rate for pancoast tumors overall is around 30%