Clinical Presentation
A 68-year-old smoker with right shoulder pain, right arm weakness, cough, and abnormal symptoms in the right eye.
Imaging Findings
(A–C) Contrast-enhanced computed tomography (CT) of the chest demonstrates a large, spiculated soft-tissue mass with central areas of necrosis in the upper lobe of the right lung that extends to the pleura and chest wall (arrows). There is rib erosion and invasion of the superior sulcus. Extensive pulmonary emphysema is also noted.
Differential Diagnosis
• Superior sulcus tumor (SST) and Pancoast syndrome: A soft-tissue mass in the lung apex that presents with invasion of the chest wall and thoracic inlet is consistent with SST. The constellation of clinical findings reported in this patient corresponds to a Pancoast syndrome.
• Bone tumor:
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