Professional Documents
Culture Documents
What is it?
What else could it be?
Clinical Presentation
Imaging Work-Up
Treatment
Prognosis
What next?
Introduction
Henry Pancoast:
early 20th century
One regionMany
names
Location
Differential Diagnosis
Malignant Tumor Pleural effusion
Pancoasts Tumor (loculated at apex)
Mesothelioma Hematoma
Lymphoma Extrapleural from
Metastatic Disease aortic rupture
Benign Tumor (most Vascular aneurysms
commonly Iatrogenic (i.e. after
Neurofibroma attempted CVC
placement)
Pleural Thickening
Associated with rib or
Status post radiation vertebral fracture
Infection (i.e. TB,
fungi, hydatid cysts)
Clinical Presentation
Arm/shoulder pain
Horners syndrome
Pancoasts Syndrome
Radiographic findings
X-Ray
Unilateral cap > 5mm
Asymmetry of bilateral caps > 5 mm
Apical mass
Bone destruction
Radiographic findings
X-Ray
Unilateral cap > 5mm
Asymmetry of bilateral caps > 5 mm
Apical mass
Bone destruction
CT
Presence of satellite nodules, parenchymal disease,
mediastinal lymphadenopathy
Radiographic findings
X-Ray
Unilateral cap > 5mm
Asymmetry of bilateral caps > 5 mm
Apical mass
Bone destruction
CT
Presence of satellite nodules, parenchymal disease, mediastinal
lymphadenopathy
MRI
Evaluation of brachial plexus, subclavian vessels, vertebral bodies,
spinal canal, and chest wall involvement
Diagnostic Work-Up
VATS
Thoracotomy
Pathology
Mediastinoscopy
Brain Imaging
Treatment
Multimodality therapy
Radiation therapy followed by en bloc
extended surgical resection
Chemotherapy/chemoradiotherapy
Prognosis