Question

A 65-year-old chronic smoker came to the medicine outpatient department with complaints of upper chest discomfort and drooping of an eyelid. He also complained of pain radiating to the upper arm and a tingling sensation in the 4th and 5th digits of his left hand. The chest X-ray is given below.

Which of the following is the most likely diagnosis?

• A. Pancoast tumour
• B. Upper lobe pneumonia
• C. Superior vena cava obstruction
• D. Aspergilloma

Answer 1

The Correct Option is A

The symptoms and background provided suggest a specific clinical diagnosis. The patient is a 65-year-old chronic smoker experiencing upper chest discomfort, drooping of an eyelid (ptosis), pain radiating to the upper arm, and a tingling sensation in the 4th and 5th digits of his left hand. These symptoms collectively guide us to the most likely diagnosis, considering the given options.

Firstly, the presence of ptosis combined with other symptoms such as arm pain and hand tingling points towards a neurological condition that affects the sympathetic nerves. This, along with the factors of smoking and chest discomfort, is a strong indication of a specific type of tumor.

Pancoast tumour, also known as a superior sulcus tumor, is a type of lung cancer occurring at the apex (top) of the lung. It often affects the nearby structures in the chest, which can cause Horner's syndrome characterized by ptosis, miosis (constricted pupil), and anhidrosis (lack of sweating) on the affected side of the face. In addition, it can cause pain in the shoulder region and the ulnar nerve distribution (4th and 5th fingers) due to involvement of the brachial plexus.

Symptom/Sign	Explanation
Ptosis	Part of Horner's syndrome due to sympathetic nerve involvement
Chest Discomfort	Due to tumor in the superior sulcus affecting nearby tissues
Arm Pain	Invasion/compression of brachial plexus by the tumor
Tingling in Fingers	Ulnar nerve involvement due to tumor
Chronic Smoking	Significant risk factor for lung cancer

The chest X-ray would likely show a mass in the upper region of the lungs, consistent with a Pancoast tumor. Based on the symptomatology and the risk factor (chronic smoking), the correct diagnosis is a Pancoast tumour.