Pancoast Tumor, Right Upper Lobe

Pancoast Tumor, Right Upper Lobe

• Apart from degenerative changes, the cervical spine is unremarkable.
  • No bone destruction is evident.
  • No fracture is seen.
  • Pre-vertebral soft tissue is normal
• Abnormal mass opacity is present in the Right Upper Lobe.
  • No rib destruction is identified.
  • R/O pneumonia, mass etc.
    • CXR is required.

Radiographic findings are consistent with the patient's history of Non-Small Cell Carcinoma. History not provided at the time of radiography.

• Clinically, pain in arm and shoulder secondary to apical tumor invading brachial plexus and sympathetic chain.
  • Sympathetic involvement leads to ipsilateral Horner's syndrome: ptosis, meiosis, anhydrosis.
• Invasion of chest wall, ribs, spine may occur.
• May be difficult to differentiate from benign apical capping on CXR.
  • CT or MR useful for pre-operative/RT assessment.

Plain film interpretation requires that the entire film be reviewed. In this case, the reason for the neck pain was the superior sulcus tumor, although indeed, bone metastasis would need to be excluded. Bone scan or CT scan would be superior in this regard.

The second point to be made is about the high frequency of requests for radiographs that have inadequate clinical histories. Every request must have:

• An admitting diagnosis or relevant clinical history.
• The reason for the present radiography.

An example would be: Lymphoma. R/O pneumonia. Radiography should not be performed without such information, even though such information may, on occasion, be misleading or irrelevant.

Ref: Armstrong, P., et. al., Imaging of Diseases of the Chest, 2nd ed, Mosby, St. Louis, MO, 1995, pp. 294-295.

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