Bone Pathology Database

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2nd image
X Ray
Third image
4th image

The chest X rays show a tumour of the apex of the Right lung. The MRI views show that the vertebral column has been infiltrated at T3 level. The bottom MRI (axial view)shows how the tumor has grown from the apex of the lung to encroach on the T3 vertebra. The patient was referred to the lung unit for further work up and treatment. A fine needle biopsy showed a poorly differentiated sarcoma. Her neurological condition deteriorated, and 1 month later she developed paraplegia due to the infiltration of her spinal cord at T3 level. Treatment was by radiotherapy.

Pancoast's tumour or Superior pulmoanry sulcus syndrome is due to a tumour at the lung apex. This condition a pitfall for the Orthopaedic surgeon, as the presenting complaint is often shoulder, or elbow pain. There may be, as in this case, neurological fall out at C8 T1 regions with intrinsic muscle atrophy of the hand.

Always consider an apical tumour in your diagnosis of shoulder, or even elbow pain, especially if there is neurological fallout in the upper limb. A chest X ray will usually show the tumour, but the condition will certainly be missed if only shoulder plates are requested

Record 119