Pancoast tumour presenting as shoulder pain with Horner’s syndrome

Shanmugathas, Nimlan; Rajwani, Kapil; Dev, Shumontha

doi:10.1136/bcr-2018-227873

Cited by 5 publications

(2 citation statements)

References 3 publications

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“…The patient's behavior of "doctor hopping and shopping" also contributed to her diagnostic delay, as no single physician was involved with ongoing assessment of her response to prescribed interventions. Similar reports of underlying Pancoast tumors in older patients with a significant smoking history have been described and these patients were often misdiagnosed or diagnosed late, which reinforce the need for maintaining a high index of suspicion in this demographic of patients when they present with shoulder and arm pain [7,[10][11][12].…”

Section: Discussionsupporting

confidence: 62%

Shoulder and arm pain: A “red herring” chief complaint in a smoker diagnosed with Pancoast-Tobías syndrome

Thompson,

Daley,

Fullerton

et al. 2024

J Case Rep Images Oncology

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Introduction: A Pancoast tumor is a rare apical lung cancer that can lead to a constellation of signs and symptoms known as Pancoast-Tobías syndrome, which involves ipsilateral shoulder and arm pain, Horner’s syndrome, and atrophy of the intrinsic hand muscles. As a Pancoast tumor progresses, it first invades the brachial plexus and causes unrelenting shoulder and arm pain in the C8-T2 nerve distributions. However, when evaluating this presenting symptom, it is often considered benign, especially in aging patients. Consequently, Pancoast-Tobías syndrome is easily misdiagnosed or delayed in diagnosis, resulting in poor prognosis, particularly for patients with advanced disease. Case Report: We present the case of an elderly Afro-Caribbean woman with a 24-pack-year smoking history who presented with unrelenting pain to the right shoulder and arm for two months. During that time, she visited multiple family physicians. Onset of pain coincided with a wasp sting that was complicated by a large local reaction. Despite clinical resolution of the inflammatory reaction, the pain persisted even with multi-modal oral analgesics. Detailed physical examination later revealed ipsilateral atrophy of the intrinsic hand muscles and focal chest findings concerning for an underlying consolidative lung process. This prompted diagnostic chest imaging, which identified a right-sided Pancoast tumor aggressively invading adjacent structures. She soon developed Horner’s syndrome, resulting in clinicoradiologic confirmation of Pancoast-Tobías syndrome. Conclusion: It is important to consider Pancoast-Tobías syndrome as an important differential of unrelenting shoulder and arm pain, even in the absence of pulmonary symptoms, in patients with risk factors for lung cancer, such as chronic smokers.

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Section: Discussionsupporting

confidence: 62%

Shoulder and arm pain: A “red herring” chief complaint in a smoker diagnosed with Pancoast-Tobías syndrome

Thompson,

Daley,

Fullerton

et al. 2024

J Case Rep Images Oncology

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“…Another unusual condition is spinal epidural abscess that typically is diagnosed based on the triad of back pain in association with fever and neurological deficiencies, HS not being a classical presentation [ 25 ]. Lesions or removal of cervical sympathetic chain (CSC) for different causes vary from frequent ones like Pancoast tumour to less frequent as schwannoma originating from CSC or cervical spontaneous intradural disc herniation [ 26 , 27 , 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid–related HS represents an unusual entity underling thyroid nodules/goiter/cancer–HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2–6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.

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Petrous apicitis presenting with Horner’s syndrome

Ibrikji

Rizk

2021

Acta Neurol Belg

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Pancoast tumour presenting as shoulder pain with Horner’s syndrome

Cited by 5 publications

References 3 publications

Shoulder and arm pain: A “red herring” chief complaint in a smoker diagnosed with Pancoast-Tobías syndrome

Shoulder and arm pain: A “red herring” chief complaint in a smoker diagnosed with Pancoast-Tobías syndrome

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Petrous apicitis presenting with Horner’s syndrome

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