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Case 33

Pancoast Tumour

An elderly man with haemoptysis

This gentleman presented with a single episode of haemoptysis and was referred for this chest film. It was incorrectly reported as normal.

Findings

There is a small soft tissue density closely applied to the upper mediastinum on the right, in the superior sulcus. No associated rib destruction is seen. This was not noticed on the initial film.

Two years later (second film, below) there is a 10cm mass in this location, consistent with a progressively enlarging tumour. However still no bone destruction is visible.

Diagnosis

Pancoast tumour of the right lung

Discussion

Pancoast tumours arise in the superior sulcus of the lung and present as apical soft tissue masses. They frequently invade the chest wall to involve the adjacent brachial plexus, causing pain and weakness in the T1 nerve distribution (medial hand and forearm), and may also produce a Horner's syndrome (enopthalmos, miosis, ptosis and anhidrosis) due to involvement of the sympathetic chain. They are usually squamous cell carcinomas and may grow quite slowly, although because of their location pleural involvement often occurs early making them inoperable. They account for approximately 5% of primary lung neoplasms.

Further examples

These two images show another example of a superior sulcus, or Pancoast, tumour. The classic feature of bone destruction is not visible in these cases, but the diagnosis of squamous cell carcinoma was confirmed histologically.

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