This patient presented for a cervical MRI for assessment of arm pain. The above coronal T1-weighted image shows an intermediate intensity mass at the right lung apex, with evidence of invasion of surrounding soft tissues.

Otherwise known as superior sulcus tumour, Pancoast tumours are primary bronchogenic carcinomas arising in the lung apex and invading the surrounding soft tissues and possibly bone. The Pancoast syndrome results from involvement of brachial plexus and sympathetic chain, and consists of: shoulder pain; C8-T2 radicular pain; and Horner’s syndrome. The classical syndrome is uncommon, with Horner’s syndrome present in only 25%. MRI is helpful in the assessment of superior sulcus tumours due to its excellent demonstration of soft-tissue involvement.

Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005

Credit: Dr Laughlin Dawes