RESUMO
CONTEXT: Non-small cell lung carcinomas (NSCLCs) of the superior sulcus are considered to be the most challenging type of malignant thoracic disease. In this disease, neoplasms originating mostly from the extreme apex of the lung expand to the chest wall and thoracic inlet structures. Multiple imaging procedures have been applied to identify tumors and to stage and predict tumor resectability in surgical operations. Clinical examinations to localize pain complaints in shoulders and down the arms, and to screen for Horner's syndrome and abnormalities seen in paraclinical assessments, have been applied extensively for differential diagnosis of superior sulcus tumors. Although several types of imaging have been utilized for diagnosing and staging Pancoast tumors, there have been almost no reports on the efficiency of whole-body bone scans (WBBS) for detecting the level of abnormality in cases of superior sulcus tumors. CASE REPORT: We describe a case of Pancoast tumor in which technetium-99m methylene diphosphonate (Tc-99m MDP) bone single-photon emission-computed tomography (SPECT) was able to accurately detect multiple areas of abnormality in the vertebrae and ribs. In describing this case, we stress the clinical and diagnostic points, in the hope of stimulating a higher degree of suspicion and thereby facilitating appropriate diagnosis and treatment. From the results of this study, further clinical trials to evaluate the potential of SPECT as an efficient imaging tool for the work-up on cases of Pancoast tumor are recommended.
Assuntos
Síndrome de Pancoast/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Idoso , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Compostos Radiofarmacêuticos , Coluna Vertebral/diagnóstico por imagem , Medronato de Tecnécio Tc 99mRESUMO
A case of Pancoast tumor presenting as cervical radiculopathy is reported, including the clinical, EMG, and radiologic findings. A 64-year-old man with a two-month history of left shoulder pain and left arm numbness at the medial aspect of the hand and forearm presented for electrodiagnostic examination, and a severe C8 radiculopathy was documented. Subsequent radiologic evaluation (myelogram and routine chest x-ray) yielded the diagnosis of left apical lung tumor (Pancoast tumor), eroding through the C7 and T1 pedicles and T1 vertebral body, with cut-off of the left C8 nerve root. Pancoast tumor has long been implicated as a cause of brachial plexopathy. The EMG presentation of isolated cervical radiculopathy, however, has not been previously reported, despite the tumor's known tendency for local invasion which may include the nerve roots and even the spinal canal in its advanced stages. This patient's normal sensory studies argue against any significant coexisting lower brachial plexopathy. The possibility of Pancoast lesion should be considered not only in the presence of brachial plexopathy, but also when C8 or T1 radiculopathy is found.
Assuntos
Síndrome de Pancoast/diagnóstico , Radiculopatia/diagnóstico , Erros de Diagnóstico , Eletromiografia , Gânglios Espinais/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Síndrome de Pancoast/diagnóstico por imagem , Síndrome de Pancoast/fisiopatologia , Radiculopatia/fisiopatologia , RadiografiaRESUMO
En el presente trabajo se analizan los hallazgos por TC en 39 pacientes con tumor del vértice pulmonar. La TC, comparada con la radiografía de tórax frente, proporciona mayor información sobre la extensión tumoral y las metástasis ganglionares mediastinales permitiendo una estadificación adecuada de la neoplasia. En 25/39 casos (64%) el diagnóstico por TC modificó significativamente la planificación terapéutica