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

INVESTIGATIONS
  1. Pancoast tumors are also difficult to see on chest x-rays due to their location.
  2. CT scans and MRI are often done
  3. Biopsy to confirm the diagnosis

TREATMENT
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%

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13 comments

  1. Anonymous Says:
  2. apploeid cancer...found mostly at top of lungs...but we need biopshy

     
  3. Anonymous Says:
  4. Neurinoma of orthosimpatic?

     
  5. Anonymous Says:
  6. well defined radiopaque lesion noted at the right apex of the lung. apical lung ca. Dx: apical lung ca with horner syndrome and brachial plexus compression.

     
  7. Shyang Says:
  8. well defined radio-opaque shadow at right upper zone of the lung.

    clinical features and x-ray findings suggestive of Pancoast Tumour.

    (apical lung tumour with local invasion into brachial plexus and sympathetic chain give rise to unilateral Horner Syndrome s described as well as the pain of right arm and numbness due to brachial plexus invasion)

     
  9. Anonymous Says:
  10. In this case, by this PA chest X-ray, we can think about cancer at the top of right lung. But by the clinical conditions, we have to think about tuberculosis. Don't forget this !

    I wonder if this patient has any other respiratoty disorder ( cough with sputum, chest pain, fever)

    Anyway, we should look more how lateral chest X-ray look like.

    After that, CT scan of chest will be performed.

    May be mantoux test will be needed for identification diagnosis. Symptoms on the right eye make me have to think about tuberculosis.

     
  11. Anonymous Says:
  12. He has Horner s syndrome and lung Ca in the right upper lobe, probably with compression of plexus brachialis..

     
  13. docromah Says:
  14. It seem to be pulmonary ca, of course it cause a Horner syndrome.

     
  15. Anonymous Says:
  16. its a pancoast tumour causin horner syndrome+ pressin on da brachial plexus...

     
  17. Anonymous Says:
  18. radio opaqe shadows in upper pole of rt lung wwhich it homogenus and have regular borders most propaly dt mediastinal lymph node enlargmentt compress in nerve plexsuss causing horner syndrome andnumbness in rt arm make ct to make sure

     
  19. Anonymous Says:
  20. Rt sided apical lung opacity well circumscribed, basal bilateral cystic changes and upper Lt side emphysematous chenges.
    DD: Pancoast tumour, Apical lung abcess, mostly its Pancoast tumour

     
  21. kirti Says:
  22. Horner syndrome secondary to pancoast tumor in the right lung

     
  23. Anonymous Says:
  24. Pancoast-Tobias tm cum Sy Horner

     
  25. Anonymous Says:
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