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Signs and Symptoms of Chest Diseases |

Pancoast's Syndrome Secondary to Apical Lung Abscess

Anas Alsadi*, MD
Chest. 2012;142(4_MeetingAbstracts):991A. doi:10.1378/chest.1390873
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Abstract

SESSION TYPE: Miscellaneous Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Pancoast’s syndrome is characterized by a mass of the superior sulcus of the lung and involvement of the brachial plexus and cervical sympathetic nerves. Apical bronchial carcinoma is the most common cause of Pancoast's syndrome. Of the many other causes reported, infection is a rare one. A case of Pancoast's syndrome, secondary to apical lung abcess is reported.

CASE PRESENTATION: 45-year-old Caucasian female with past medical history including type 2 diabetes, hypertension, dyslipidemia, who presented to ED with increasing malaise, fatigue, weakness, and right-sided chest pain, neck pain and shortness of breath. Her chest x-ray on admission revealed no abnormalities. She was treated with pain medication. Her symptoms persisted. She had a CTA of the Chest which revealed a soft tissue mass located at the right lung apex medially and abuts the trachea, esophagus, and adjacent vertebral body. CT soft tissue of the neck revealed right apical lung mass, which is partially contiguous with the right scalene musculature. Patient complained of right hand numbness and weakness, for which MRI of the neck was done and confirmed earlier findings. Bronchoscopy showed normal endobronchial tree, and an ultrasound guided transbronchial needle aspiration of the right upper lobe mass was negative for malignant cells. Aspirate from the mass grew Streptococcus Viridans. Patient treated wit antibiotics and underwent anterior neck exploration of the right apical lung mass to relieve her brachioplexopathy

DISCUSSION: Pancoast’s syndrome includes Horner’s syndrome, atrophy of he hand muscles and shoulder, axilla or arm pain. This syndrome is caused by an apical thoracic lesion, most commonly a bronchogenic carcinoma. Causes of Pancoast’s syndrome not related to malignancy are recognized. Among the benign conditions causing Pancoast’s syndrome, infections are extremely rare. A wide variety of organisms were identified but no single organism could be labeled as the most prevalent. Overall, bacteria (54.8%) seem to be the most common organisms with S aureus being the most frequent of these. Infection is a treatable etiology of Pancoast’s syndrome.

CONCLUSIONS: Infection is a treatable etiology of Pancoast’s syndrome.

1) Pancoast’s Syndrome Secondary to Infectious Etiologies: A Not So Uncommon Occurrence Heath D. White, DO, MS, Bobbie Ann A. White, MA, Carl Boethel, MD and Alejandro C. Arroliga, MD. Send to: Pancoast's syndrome secondary to infectious etiologies: a not so uncommon occurrence. White HD, White BA, Boethel C, Arroliga AC. Am J Med Sci. 2011 Apr;341(4):333-6.

2) Mehrotra A, Raj A, Tripathi K. Apical pulmonary tuberculosis presenting with Pancoast syndrome like features. J Assoc Physicians India 2001;49:380-1

3) Comet R, Monteagudo M, Herranz S, et al. Pancoast’s syndrome secondary to lung infection with cutaneous fistulisation caused by Staphylococcus aureus. J Clin Pathol 2006;59:997- 8.

DISCLOSURE: The following authors have nothing to disclose: Anas Alsadi

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, Temple, TX

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