Imaging Findings

(A) Chest radiograph demonstrates a left apical mass with destruction of the first rib (arrows). (B) Coronal computed tomography (CT) reconstruction (soft-tissue windows) shows the mass to advantage (arrow). (C) Axial T2-weighted magnetic resonance imaging (MRI) shows a large left apical mass of heterogeneous signal intensity. There is chest wall invasion (arrow), but no encroachment on the spinal cord. (D) Coronal positron emission tomography (PET) scan documents the highly fluorodeoxyglucose-avid mass in the left apex (upper arrow). Note the adjacent hypermetabolic lymph node and left adrenal gland metastasis (lower arrow).

  Differential Diagnosis