Answer
Answer
Posteroanterior (PA) chest radiographs show unilateral apical opacity (as seen in the image below) or just asymmetry of the apices greater than 5 mm. Local rib destruction can sometimes be observed. Lordotic chest views can be beneficial, but the findings can also be misleading. In the early stages, Pancoast tumors are difficult to detect on PA chest radiographs because of the difficulty in interpreting overlying shadows at the apices.
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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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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