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Chronic smoker presented with 2 months bilateral upper limb weakness, breathlessness and hemoptysis
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There is a large ill-defined space occupying lesion arising from superior sulcus of right upper lobe. This appears heterogeneously isointense-hypointense on T2WI, hyperintense with few hypointense areas of calcification/necrosis on T1WI, and hyperintense on STIR images encasing trachea, and pushing it to left. Additionally it encases the right subclavian vessels, roots, trunks and divisions of right brachial plexus, invading the muscles and soft tissues of right supraclavicular region, destruction of cervical vertebral bodies and intervertebral disc spaces.
Looking at the degree of invasion and imaging findings of the lesion the most likely diagnosis is a Pancoast tumor.