Presentation
History withheld.
Patient Data
There is a mass lesion involving the left superior sulcus, infiltrating into the left lateral aspect of the T1 to T4 vertebral bodies and involving the left T1/T2 and T2/T3 neural foramina, not demonstrating epidural extent. The tumor encases the proximal left subclavian artery and left vertebral artery origin and involves the lower trunk of the left brachial plexus.
No remote cervical canal stenosis. No regions of abnormal cord signal change.
Conclusion: Left superior sulcus tumor (Pancoast tumor) with infiltration into the T1-T4 thoracic vertebral bodies and left T1-T3 neural foramina with encasement of the proximal left subclavian artery, left vertebral artery origin and lower trunk of the brachial plexus.
Case Discussion
Pancoast tumors are non-small cell carcinomas that arise from the lung apex and invade the thoracic inlet. MRI is often used to examine the contiguous tumor progression in the superior sulcus towards the brachial plexus, vertebral bodies, intervertebral foramina, intraspinal space, and subclavian vessels.
Fat suppression images and contrast can be use to distinguish tumor from normal tissue. Note that following chemoradiation, there may still be remaining enhancing tissue but this is usually only reactive fibrous tissue without viable tumor cells.
Case courtesy of A/Prof Pramit Phal.
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