Apical lung mass mimic - neurogenic tumor
This is a good learning case - both practical and for fellowship examinations.
- One could easily miss the chest x-ray findings. Review areas are highlighted for a purpose.
- A biopsy however well done is invasive and comes with risks. Reserve biopsy for when one's intelligence and full range of diagnostic tests have been exhausted. A CT guided biopsy was requested after the diagnostic CT and the radiologist advised MRI cervical spine first.
- Not every apical mass is in the lung and not every mass is cancer. Have a differential.
- The MRI illustrates this is a neurogenic and almost certainly benign nerve sheath tumor.
- Clinicoradiological discussion almost always adds positively to patient care
No biopsy was undertaken. The differential for this neurogenic tumor includes schwannoma, neurofibroma and ganglioneuroma.
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