Left shoulder pain.
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The patient's scout demonstrates opacity of the left lower neck, left lung apex and destruction of the left first rib. CT images show a large soft tissue mass involves the apex of the left lung with subsequent destruction of the proximal end of the left 1st and 2nd ribs, the left border of T1 and T2 vertebrae as well as their transverse processes on the left side. There is evidence of extension of the mass into the left T1-T2 and T2-T3 neural exits with subsequent extra-dural components.
As regards the previous findings, primary tumors of the bone and pleura, as well as metastasis, are considered the main differentials for pancoast tumor.
Pancoast tumors originate from the lung seen at the apical pleuropulmonary groove (superior sulcus). By direct extension, they invade the lower trunks of the brachial plexus, intercostal nerves, related ribs, and vertebrae. Almost 95% of pancoast tumors are non–small cell carcinomas.