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A Pancoast tumor, also known as a superior sulcus tumor, is a lung carcinoma located at the pulmonary apex, typically involving the apical chest wall, brachial plexus, and adjacent structures.
It is usually a subtype of non–small cell lung cancer (NSCLC), especially squamous cell carcinoma or adenocarcinoma.
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https://www.youtube.com/watch?v=Ou2DHo6w4fY
Pancoast syndrome:
| Feature | Cause |
|---|---|
| Shoulder and arm pain | Invasion of brachial plexus (esp. lower trunk) |
| ‣ | |
| (ptosis + miosis + ipsilateral anhidrosis) | Invasion of sympathetic chain |
| Weakness/atrophy of hand muscles | Brachial plexus (T1 nerve root) |
| Chest wall mass or swelling | Chest wall invasion |
Horner’s syndrome =
https://youtu.be/sKu15_JrGxQ?si=4LbwZVg0mfuO8qyo
| Modality | Imaging features |
|---|---|
| CXR | • May show an apical mass obscuring the superior pulmonary sulcus |
| • Often under-recognized due to overlying structures | |
| • Associated rib destruction may be seen in advanced cases | |
| CT | • Apical soft tissue mass, typically in the superior sulcus |
| • Bone erosion (1st/2nd rib, vertebral body): Suggests locally advanced disease | |
| • Neurovascular encasement: Brachial plexus, subclavian artery/vein | |
| • Pleural or parietal invasion: Thickening or disruption of fascial planes | |
| MR | Best modality for evaluating extent of neurovascular invasion |
| • Brachial plexus | |
| • Subclavian vessels | |
| • Spinal canal or foraminal extension | |
| PET-CT | Staging modality: Detects nodal and distant metastases |
| Modality | Utility |
|---|---|
| CT-guided biopsy | For peripheral tumor sampling |
| EBUS / mediastinoscopy | For nodal staging (N2/N3) |
| MRI | Preoperative planning for resection extent |
| PET-CT | Whole-body staging |