Presentation
A smoker presents with upper limb weakness, more on left side, breathlessness, hemoptysis.
Patient Data
A large soft tissue mass is seen centered in the apex of left lung, appears isointense on T1WI and hyperintense on T2WI, with small hyperintense cystic degeneration; it shows enhancement in t1_vibe post contrast.
It invades fat above apical pleura and the left posterior chest wall, extends from C7 vertebral body level down to D3 level, invading these vertebral bodies medially, obliterating their left neural foramina with adjacent ribs destruction, encasing the brachial plexus on left side, extends to posterior elements, left paraspinal muscles.
Obliteration of the spinal canal and compressing spinal cord and causes secondary spinal canal stenosis mainly at D2 level
Loss of height of D2 vertebral body, retropulsion into the spinal canal, with hyperintensity t2 signal intensity, likely pathological fracture.
Lesser degree anterior wedging of D1 vertebral body.
Case Discussion
Large enhanced soft tissue mass centered in apex of left lung, infiltrating dorsal vertebral bodies, adjacent ribs, likely neoplastic lesion, suggestive Pancoast tumor/ superior sulcus tumor.
Pathologically proved bronchogenic adenocarcinoma.
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