What's the most likely diagnosis?

• 73 year-old with left arm pain

1. Tuberculosis
2. Subclavian artery aneurysm
3. Mesothelioma
4. Pancoast Tumor
5. Sarcoidosis

Additional Image-close-up of a portion of the lung

 

Additional Image

 

Close-up of the apex of the left lung

Answer:

 

4. Pancoast Tumor (Superior Sulcus Tumor)

 

 

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Pancoast Tumor

General Considerations

• A lung tumor arising in the superior sulcus and comprising fewer than 5% of all primary lung cancers
• Described by Henry Pancoast in 1932
• The majority of the tumor growth is extrathoracic
• Directly invades
  • Adjacent ribs, especially the 1^st, 2^nd and 3rd
  • Vertebrae
  • Brachial plexus
• Stellate ganglion
• Most are squamous cell carcinomas
  • Fewer than 5% are small cell carcinomas

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