Left apical pancoast tumor on shoulder x-ray

Case contributed by Chris Newman
Diagnosis certain


Painful left shoulder and scapula following fall.

Patient Data

Age: 80 years
Gender: Male
  • no shoulder fracture or dislocation
  • large left upper lobe pulmonary lesion with an irregular margin
  • linear opacity within the left mid-zone, likely reflecting atelectasis
  • some ill-definition of the left upper ribs
  • the CT confirms the presence of a left upper lobe mass, which is eroding several upper thoracic ribs
  • the mass is fairly homogenous in its appearance
  • evidence of background emphysematous changes

Case Discussion

This case illustrates the importance of the hemithoraces as a check area on shoulder x-ray - it is important not to miss lung abnormalities, particularly cancer.

This patient went on to have completion CT imaging as well as a CT/PET scan, confirming the diagnosis of a Pancoast tumor.


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