Pancoast tumor

Case contributed by Dr Ian Bickle

Presentation

ESR 61. Persistent boney pains right posterior rib/scapular area. Cause?

Patient Data

Age: 75 years
Gender: Female
X-ray

Hyperinflated lungs.

5cm right apical mass with destruction of the 2nd and 3rd ribs.

Heart size normal.

CT

5.5 cm soft tissue mass peripherally in the right upper lobe, infiltrating into chest wall with lytic destruction of the posterior ends of right second and third ribs and costovertebral junction. Background of emphysema and bronchial wall thickening bilaterally.

No significant mediastinal lymphadenopathy.

3 cm mass on the left adrenal, most likely metastasis. Normal spleen, pancreas and left kidney. The right kidney is very atrophic with a dilated pelvicalyceal system.

CT

Prone.

Core biopsy of the right apical pulmonary mass.

Case Discussion

Appearances are of a Pancoast tumor (lung cancer). 

CT staging is T3N0M1b.

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