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An Approach to Pupillary Disorders
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Sarosh M. Katrak, Azad M. Irani
The preganglionic second-order neurons lie at the base of the neck and ascends up to the superior cervical ganglia located at the level of bifurcation of the common carotid artery and the angle of the jaw. In a large series of HS, an etiological diagnosis was made in 44% of patients with a preganglionic lesion [6]. The most common etiology was malignant tumors of the apex of the lungs (Pancoast tumor) or metastasis from breast cancer. The Pancoast tumor may also involve the brachial plexus with pain in the shoulder and arm. Therefore, this tumor should be considered in any patient with a non-traumatic, new-onset HS and shoulder or arm pain, particularly in elderly males who are smokers. Direct trauma to the spinal cord during forceps delivery may produce a HS together with upper arm palsy (Klumpke palsy) [11].
The shoulder
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
A high index of clinical suspicion is necessary to recognise a Pancoast tumour. This bronchogenic carcinoma affecting the apex of the lung may well produce pain referred to the tip of the shoulder. It is a great advantage in conditions such as these if the primary contact physician makes an early diagnosis. Where this does not happen, the patient with shoulder pain who is referred to a hospital rheumatological clinic may well wait up to 3 or 4 months for an outpatient appointment, by which time a late diagnosis of bronchogenic carcinoma can be catastrophic for the patient. In such instances, there is a strong case for general practitioners (GPs) who see their patients often at the onset of symptoms to be expert at diagnosing and treating these soft tissue disorders.
Multiple choice questions (MCQs)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
Ultrasound is indicated for the investigation of the following suspected diagnoses? Cholecystitis.Osteomyelitis.Pancoast tumour.Pyelonephritis.Deep venous thrombosis.
Superior sulcus tumor disguised as cervical radiculopathy with metastasis to brachial plexus
Published in Baylor University Medical Center Proceedings, 2019
James Rizkalla, Seagal Dauglas, Scott Nimmons, Waleed El-Feky, Ishaq Syed
Though documented in literature, the spread of carcinoma and sarcoma to peripheral nerve cells is exceedingly rare.5 More specifically, metastasis of a Pancoast tumor to the brachial plexus, causing the initial presentation of the tumor, is extremely rare and has only been described in a handful of cases. This case report describes a rare clinical presentation of a Pancoast tumor that may easily be confused with cervical radiculopathy. In this case, physical examination remained critically important in the diagnosis. The patient’s brachial plexus lesions were missed by previous orthopedic surgeons and resulted in an unsuccessful and unnecessary cubital tunnel release in an attempt to resolve his symptoms. A thorough history and physical examination painted a picture of symptoms that was not fully conclusive on MRI. The patient’s vague distributions of pain with inconsistencies with nerve distribution complicated the diagnostic picture. As stated by Woods et al,3 often the MRI findings reveal nearly universal degenerative changes within the spine and may cloud a diagnostician’s clinical picture if a thorough physical examination is not performed. With a physical exam that did not perfectly match MRI findings, additional studies were needed. This was the initial presentation of this patient’s Pancoast tumor and, without additional workup, may have been missed altogether.
Lung cancer: active therapeutic targeting and inhalational nanoproduct design
Published in Expert Opinion on Drug Delivery, 2018
Nasser Alhajj, Chin Fei Chee, Tin Wui Wong, Noorsaadah Abd Rahman, Noor Hayaty Abu Kasim, Paolo Colombo
SCLC (20%) and NSCLC (80%) differ from each other in the sizes and locations of their cells [5]. SCLC locates in the central area of the lungs mainly in the bronchi [6]. SCLC is an aggressive, fast-growing lung cancer. It can be further classified into oat cell cancer and combined small cell carcinoma. NSCLC is available in four subtypes: large cell undifferentiated carcinoma (10–15%), squamous cell carcinoma (30%), adenocarcinoma (40%) [7], and pancoast tumor (<5%) [8]. The lung adenocarcinoma has heterogeneous histological profiles. It can constitute of two or more of the following variants: acinar, papillary, bronchioloalveolar, or solid with mucin. The adenocarcinoma may be originated from bronchiolar or alveolar tissues, but it tends to locate in the peripheral parts of the lungs [9–11]. The squamous cell lung carcinoma is classified as keratinizing, nonkeratinizing, and basaloid variants [12]. Seventy percent of squamous cell lung carcinoma occurs as central tumors, whereas 30% as peripheral tumors [13,14]. Large cell undifferentiated carcinoma is a rapid growing cancer with a high spread rate. It cannot be identified histologically as one of the NSCLC. All large cell undifferentiated carcinoma variants tend to be located in the peripheral lung except basaloid carcinoma [11]. Pancoast tumor is formed when the squamous cells are located in the lung superior sulcus and start to spread to the posterior ribs and bones of the spine and can cause Horner’s syndrome [8,11]. Surgery is not opted for this lung cancer type because it is very close to the nerves and spine.
Abstracts book
Published in Acta Clinica Belgica, 2020
Clinical examination showed global non-pitting edema of the right upper limb with venous stasis. There was no objective sensorimotor loss in the right upper limb. A mass in the right supraclavicular fossa was felt without other adenopathy. The patient was afebrile and no Horner’s sign was noted. A CT Thorax showed a large Pancoast tumor with a maximal diameter of 10.6 cm in the upper right lobe with invasion of the neck base and local neurovascular structures.