Pancoast tumor differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Pancoast tumor from other Diseases

Pancoast tumor must be differentiated from other causes of mass located in the apical region of the chest which may present with pain in the shoulder region. Differential diagnosis of Pancoast tumor is as follows: Pancoast tumor is a subtype of lung cancer with characteristic location at the lung apex, must be differentiated from other diseases that cause chronic cough, weight loss, hemoptysis, and dyspnea among adults such as tuberculosis, pulmonary fungal disease, lung abscess, and secondary metastases.[1][2][3]

Differential Diagnosis

Differential Diagnosis Similar Features Differentiating Features
Pulmonary tuberculosis Chronic cough, weight loss, hemoptysis, nocturnal diaphoresis, dyspnea In pulmonary tuberculosis, differentiating features include: resolution (or decrease in size) after medical therapy, patients age is usually younger, hemoptisis is an early feature, and CXR anatomical predilection for upper lobes
Lung abscess Chronic cough, weight loss, hemoptysis, and dyspnea In lung abscess, differentiating features include: acute or subacute onset, CXR anatomical predilection for upper lobes, and usually resolve with antibiotic
Pneumonia Cough, fatigue, and dyspnea In pneumonia, differentiating features include: high grade fever, good response to antibiotics, acute onset, predilection on CXR is consolidation, laboratory markers indicate infection
Fungal infection Chronic cough, weight loss, hemoptysis, and dyspnea In fungal infection, differentiating features include: CXR findings (air-cresecent sign), no response to antibioitcs, and mimcs tuberculosis
Chronic eosinophilic pneumonia Chronic cough, weight loss, hemoptysis, and dyspnea In chronic eosinophilic pneumonia , differentiating features include: parasite infection or medication exposure, and increased serum IgE levels

In superior vena cava syndrome, obstruction of the superior vena cava by a tumor (mass effect) causes facial swelling, cyanosis and dilatation of the veins of the head and neck.

A pancoast tumor is an apical tumor that is typically found in conjunction with a smoking history. The clinical signs and symptoms can be confused with neurovascular compromise at the level of the thoracic outlet. The patient's smoking history, rapid onset of clinical signs and symptoms, and pleuritic pain can suggest an apical tumor.

References

  1. 1.0 1.1 Bhatt M, Kant S, Bhaskar R (2012). "Pulmonary tuberculosis as differential diagnosis of non-small cell lung cancer". South Asian J Cancer. 1 (1): 36–42. doi:10.4103/2278-330X.96507. PMC 3876596. PMID 24455507.
  2. 2.0 2.1 Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S (2011). "[Lung abscess which needed to be distinguished from lung cancer; report of a case]". Kyobu Geka. 64 (13): 1204–7. PMID 22242302.
  3. 3.0 3.1 Matsuoka T, Uematsu H, Iwakiri S, Itoi K (2013). "[Chronic eosinophilic pneumonia presenting as a solitary nodule, suspicious of lung cancer;report of a case]". Kyobu Geka. 66 (10): 941–3. PMID 24008649.

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