Apical chest masses are often important and may be missed, especially when examined with a plain chest radiograph. It is always recommended to perform a targeted assessment of the apices of the lungs during a chest x-ray; they are one of the classic review areas.
Pathology
Etiology
Commonly an apical chest mass is a Pancoast tumor 1, however sometimes other lesions need to be considered in the differential diagnosis 2:
- lung metastasis
- pleural tumors 3: mesothelioma, lymphoma, metastasis
- chest wall tumors 4: chondrosarcoma, Ewing sarcoma, metastasis
- neurogenic tumors
- apical pleural thickening secondary to, e.g. previous pulmonary tuberculosis
- pulmonary apical fibrosis
- mycetoma in an apical cavity
- vascular lesions: subclavian artery aneurysm, carotid artery pseudoaneurysm 5
- plombage
- anterosuperior mediastinal masses
- meningocele - rare
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