A 55-Year-Old Man With Worsening Cough and Drooping Eyelid: Osmosis USMLE Question

October 04, 2019

Answer: C. Pancoast tumor

Pancoast tumors are lung cancers defined primarily by their location at the pulmonary apex. Apart from the general symptoms usually associated with cancers, such as unintentional weight loss, fever, malaise, and fatigue, Pancoast tumors may lead to several other syndromes caused by the compression of surrounding anatomical structures.

Thoracic outlet syndrome, caused by the compression of the neurovascular bundle of the upper limb, is characterized by upper extremity swelling, diffuse arm or hand pain, paresthesias, and in severe cases, ulceration or venous or arterial gangrene.

Horner syndrome, or oculosympathetic palsy, is a clinical syndrome caused by the compression of the paravertebral sympathetic chain and the inferior cervical ganglion. It is characterized by homolateral miosis, ptosis, enophthalmos, and anhidrosis. Extension into the nerve roots of C7, C8, T1, and T2 may cause atrophy, pain, and paresthesias down those dermatomes. Compression of the superior vena cava leads to superior vena cava syndrome, which may present with dyspnea, headache, facial swelling, venous distention in the neck, upper limb edema, lightheadedness, cough, edema of the cervical region, and a positive Pemberton sign (facial congestion and cyanosis after the individual has elevated his arms above his head for approximately one minute).

Major Takeaway: Pancoast tumors are rare lung neoplasms situated at the pulmonary apex, which, by extension or compression, affect nearby anatomical structures, leading to Horner syndrome, thoracic outlet syndrome, or superior vena cava syndrome.

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