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304 North Cardinal St.
Dorchester Center, MA 02124

Superior Sulcus Tumor


KEY FACTS

Terminology

  • Synonym: Pancoast tumor

  • Benign or malignant neoplasm extending to superior thoracic inlet with severe shoulder/arm pain along C8, T1, T2 nerve trunks, Horner syndrome, weakness + atrophy of intrinsic hand muscles (Pancoast syndrome)

Imaging

  • Soft tissue apical lung mass with variable extension into chest wall, adjacent bone destruction, brachial plexus invasion

Top Differential Diagnoses

  • Metastatic disease

  • Other thoracic tumors [besides nonsmall cell lung carcinoma (NSCLC)]

  • Brachial plexus neural tumors

  • Hematologic neoplasms

  • Radiation fibrosis

  • Vascular (venolymphatic) malformation

  • Infection

Pathology

  • Bronchogenic carcinomas may arise from either upper lobe

  • Invades parietal pleura, endothoracic fascia, subclavian vessels, brachial plexus, vertebral bodies, and upper ribs

  • NSCLC most frequent etiology

Clinical Issues

  • Clinical findings determined by tumor location relative to scalene muscles

  • Severe shoulder and arm pain

  • Horner syndrome

  • Pulmonary symptoms uncommon early in disease course

Diagnostic Checklist

  • Apical lung mass with bone destruction = bronchogenic carcinoma until proven otherwise

  • Rare benign tumors or infection may mimic lung carcinoma

Coronal STIR MR [nonsmall cell lung carcinoma (NSCLC), arm pain and weakness] shows extensive architectural distortion of the lung apex by a peripheral lung mass
with extension along the brachial plexus elements
.

Coronal T1 C+ FS MR (NSCLC, arm pain, and weakness) demonstrates a heterogeneously enhancing apical lung neoplasm
with tumor extension
along the lower brachial plexus elements.

Axial CECT demonstrates a soft tissue mass
involving the right upper lobe with extension beyond the chest wall producing destruction of right T1, T2 ribs
.

Axial PET (FDG) CT fusion image reveals marked hypermetabolic radiotracer uptake within the right upper lobe bronchogenic carcinoma
.

TERMINOLOGY

Synonyms

  • Pancoast tumor

Definitions

  • Benign or malignant neoplasm extending to superior thoracic inlet with severe shoulder/arm pain along C8, T1, T2 nerve trunks, Horner syndrome, weakness + atrophy of intrinsic hand muscles (Pancoast syndrome)

    • Nonsmall cell lung carcinoma (NSCLC) most frequent etiology

IMAGING

General Features

  • Best diagnostic clue

    • Soft tissue mass involving lung apex with adjacent rib destruction

  • Location

    • Lung apex and adjacent chest wall, brachial plexus, cervicothoracic junction vertebral bodies

  • Size

    • Variable

  • Morphology

    • Apical soft tissue mass with ill-defined margins, bone destruction

Radiographic Findings

  • Radiography

    • Soft tissue density at lung apex, ± 1st or 2nd rib destruction

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