Presentation
Painful left shoulder and scapula following fall.
Patient Data
Age: 80 years
Gender: Male
From the case:
Left apical pancoast tumor on shoulder x-ray
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/119273/annotated_viewer_json?iframe=true\u0026lang=us"}
- 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
From the case:
Left apical pancoast tumor on shoulder x-ray
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/119274/annotated_viewer_json?iframe=true\u0026lang=us"}
- 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.