CXR Case 069

A 67 year old male presents with worsening left shoulder and arm pains.

click images to enlarge


Describe and interpret this CXR and CT chest

IMAGE INTERPRETATION

CXR Interpretation:
There is infiltration of the left apex with a large soft tissue mass with rib destruction/invasion.
Lung fields appear over-inflated consistent with COPD.

CT Interpretation:
CT confirms the presence of an invasive tumour with clavicle, 1st and 2nd rib destruction.


CLINICAL CORRELATION

This is a left sided Pancoast tumour.


CLINICAL PEARLS

In some circumstances surgery is possible with Pancoast tumour – usually a lobectomy and some rib / chest wall resection.

MRI is very useful at informing the degree of any soft tissue invasion.

Otherwise, adequate analgesia to cover the local and neuropathic pain (brachial plexus invasion) with radiotherapy, is indicated for symptom control.


TOP 150 CXR SERIES



Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar |

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