Presentation
Headache, vomiting and syncopal attacks. Cerebral space occupying lesions on CT.
Patient Data
Irregular shaped ill defined right apical lung mass is seen invading the right aspect of T2 vertebral body and its transverse process, costovertebral junction and the adjacent 2nd rib, and inferiorly the 3rd rib. Superiorly it extends to the root of the neck. A background of centrilobular and paraseptal emphysema noted.
Diagnosis: Pancoast tumor (adenocarcinoma by biopsy)
Two left frontal parasagittal and left cerebellar cystic lesions are noted, the latter one shows fluid-fluid level with T1 hyperintense signal likely hemorrhage. They show rim enhancement after contrast and surrounded by brain edema exerting mass effect upon the left lateral ventricle and left aspect of pons.
Diagnosis: cystic metastasis from adenocarcinoma of the lung
Case Discussion
Pancoast tumor (also known as a superior sulcus tumor) is a subtype of non-small cell lung cancer that involves the apical lung and may extend outside the thoracic cavity into the root of the neck.
It may manifest as numbness and weakness of the upper limb from compression/invasion of the brachial plexus. Histologically and historically, Pancoast tumors were most commonly squamous cell carcinoma, but adenocarcinoma are now the commonest subtype.
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