Radiologic Multimodality Approach in a Case of Pancoast Tumor with Bone Lytic Lesions

Abstract

Lung cancer was the second most common malignancy and the leading cause of cancer-related mortality worldwide in 2020, accounting for 1.8 million deaths. Delayed diagnosis often leads to advanced-stage presentation and poor long-term survival. Pancoast tumors, a rare subset of superior sulcus lung cancers, may present with atypical neurologic signs. We report a 55-year-old man with a 6-month history of right chest pain and progressive dyspnea. Physical examination was unremarkable apart from mild right eyelid ptosis without a full Horner’s syndrome. Chest X-ray and contrast-enhanced CT demonstrated an apical mass in the right upper lobe with lytic lesions of the first and second ribs. Bronchoscopic biopsy confirmed non–small cell lung carcinoma consistent with a Pancoast tumor. The patient underwent surgical resection of the apical mass with regional lymphadenectomy, followed by platinum-based chemotherapy. Postoperative imaging revealed residual disease, prompting additional chemotherapy cycles. At six-month follow-up, the patient experienced marked pain relief and partial resolution of ptosis, with no new metastatic foci on imaging. High clinical suspicion and a multidisciplinary radiologic and histopathologic approach are essential for early diagnosis and optimal management of Pancoast tumors.