Question

A 45-year-old patient presents with ptosis and muscle weakness that improves with rest. She also complains of dysphagia and has engorged veins in her thorax. Based on the CT scan image provided, what is the most likely diagnosis? 

• A. Thymoma
• B. Pancoast tumor
• C. Adenocarcinoma
• D. Small cell lung cancer

Hint:

When a patient presents with ptosis, muscle weakness, and dysphagia along with chest imaging abnormalities, consider thymoma as a potential cause, especially in the context of myasthenia gravis.

Answer 1

The Correct Option is A

The combination of ptosis, muscle weakness, and dysphagia, along with the engorged veins seen on the CT scan, suggests myasthenia gravis (MG), which is frequently associated with a thymoma. Thymomas are tumors of the thymus gland and are commonly seen in patients with MG. The engorged veins are likely due to superior vena cava syndrome, which can occur in the context of a thymoma. The thymus gland is located in the chest, and thymomas are often detected on chest imaging.
- Pancoast tumors are located at the apex of the lung and typically present with shoulder pain, arm weakness, and Horner’s syndrome. They do not cause the classic symptoms of MG or the associated findings.
- Adenocarcinoma is a common type of lung cancer but is not specifically linked to myasthenia gravis or the symptoms seen in this case.
- Small cell lung cancer may also present with similar symptoms due to paraneoplastic syndromes, but the classic association with MG points to thymoma.
Thus, the most likely diagnosis is thymoma.