Phrenic nerve palsy and metastases

Case contributed by Frank Gaillard
Diagnosis certain

Chest x-ray demonstrates a soft tissue mass at the apex of the right lung, abutting the mediastinum medially. This is associated with marked elevation of the right hemidiaphragm, with no evidence of mediastinal shift of pleural fluid. 

CT confirms the presence of the apical mass which is invading the mediastinum, and presumably involving the phrenic nerve resulting in a phrenic nerve palsy. 

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