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Pancoast Tumor  

• Arises in the superior sulcus of the lung which is a groove formed by the subclavian artery

• Unique among parenchymal processes for its propensity to violate the pleural barrier and involve chest wall

• Bone destruction is common — first rib most often affected

• Squamous cell is most common cell type

Complications  

• Brachial plexus involvement on affected side

• Horner’s syndrome on affected side

• Ptosis

• Myosis

• Anhydrosis

• And rarely, enopthalmus

• Superior vena caval obstruction when tumor occurs on right

   X-ray

• Apical cap on affected side; flat, uniform density

• DDX: apical pleural thickening

• Other side is usually normal in Pancoast, thickened with apical pleural thickening

• Key to diagnosis is demonstration of bone involvement

• MR demonstrates blood vessel, brachial plexus and vertebral canal involvement

• Bone scan may be needed to demonstrate bone involvement if clinical suspicion is high

 WH/92

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