Pancoast Syndrome is usually associated with apical extension of a primary lung cancer (see 27.09.09). Other conditions need to be considered in the differential diagnosis. It is important to establish the cause before rushing to judgment.


Features of Pancoast Syndrome may include:

(1) Horner syndrome

(2) shoulder pain

(3) pain in the axilla and/or arm

(4) atrophy of hand muscles

(5) complex regional pain (reflex sympathetic dystrophy) involving the ipsilateral upper extremity


Pancoast's syndrome arises from an apical lesion that invades or compresses:

(1) the roots of the brachial plexus

(2) cervicothoracic sympathetic chain


Depending on the location and extent of the lesion there may be an element of lateral thoracic outlet obstruction (17.44.18). This may include ischemic change in the ipsilateral upper extremity secondary to compression of the arterial blood or edema from venous compression.


Conditions other than lung cancer causing Pancoast Syndrome:

(1) malignant lymphoma

(2) multiple myeloma

(3) metastatic cancer from other sites

(4) tuberculosis

(5) deep fungal infection of the lung

(6) thoracic actinomycosis

(7) bacterial abscess or empyema

(8) parasitic infection


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