Answer
Answer
Magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) scanning and radiography in iidentification of the extent of tumor involvement and detection of invasion of adjacent organs (eg, vertebral bodies, brachial plexus, subclavian vessels). [10, 11, 12, 13] Histologic diagnosis is made in 95% of the cases by means of percutaneous transthoracic needle biopsy with fluoroscopic, ultrasonographic, or CT scan localization. [5, 14, 15] Among other considerations, CT scanning or MRI of the brain is recommended in the initial evaluation, because distant metastases to the brain are not infrequent, and diagnosis of these metastases is necessary for staging. [16, 6, 7]
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Media Gallery
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Pancoast tumor. A 53-year-old man with a 50 pack-year history of smoking began experiencing upper back pain for several weeks. PA chest radiograph shows asymmetry of the apices (superior sulcus). The right apex is more opaque than the left. When the image is enlarged, the partially destroyed second and third right posterior ribs near the costovertebral junction can be seen.
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Pancoast tumor. Axial nonenhanced CT image of the upper dorsal spine demonstrates a soft tissue mass destroying the vertebra on the right and the right posterior elements, including the pedicle and part of the posterior spinous process.
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Pancoast tumor. Sagittal fast spin-echo T2-weighted MRI shows collapsed vertebrae and cord compression at C7, T1, and T2 caused by a soft tissue mass.
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Pancoast tumor. Sagittal gradient-echo T2-weighted MRI demonstrates a soft tissue mass involving C7, T1, and T2, with collapse of the vertebrae and moderate cord compression.
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Pancoast tumor. Axial T1-weighted image shows cord compression caused by a large, enhancing mass. The right subclavian artery is not involved.
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