Presentation
Neck pain radiating into left arm
Patient Data
Contrast enhancing low T1, high T2 mass centered on the left lung apex. Superiorly, the mass extends into the left T1-2 neural exit foramen and into the left epidural space, but without severe canal narrowing or contact of the spinal cord. Bony destruction of the T1 vertebral body, invasion of left longus colli muscle and erosion of the inferior left first rib.
Anteriorly the mass is in contact with the left subclavian artery and encases the left vertebral artery, however, both have preserved T2 flow-voids.
Multilevel mid cervical degenerative disc with thickening of the posterior longitudinal ligament resulting in mild central canal stenosis. Moderate right C5-6 and C6-7 neural exit foraminal stenoses.
Visualized spinal cord is of normal signal intensity and caliber.
Involvement of the inferior roots and trunks of the brachial plexus as they pass between the anterior and middle scalene muscles.
No enlarged mediastinal or suprascapular fossa lymph nodes.
Case Discussion
The patient went on to be diagnosed with diffuse large B cell lymphoma with complete macroscopic resolution on follow-up imaging after 6 months of chemotherapy. The position of the mass at the lung apex mimics a Pancoast tumor.
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