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來源：熊貓放射
譯者：花人青老師
History: A 45-year-old woman presents with pain in her upper back and persistent pain and limited use of her left arm.
病史：45歲女性，上背部疼痛，左臂持續(xù)疼痛，運(yùn)動(dòng)受限。
Posteroanterior (PA) radiograph of the chest is shown below.
胸部正位片如下所示。
CT images
Axial contrast-enhanced CT images of the thorax in soft-tissue windows are shown below.
胸部CT增強(qiáng)掃描（軟組織窗）如下所示。
胸部CT增強(qiáng)軸位及冠狀位肺窗圖像如下所示。
Findings
Chest radiograph: The PA radiograph of the chest reveals an opacity in the left upper lung apex.
Chest CT: Contrast-enhanced CT of the chest revealed a centrally necrotic spiculated mass, abutting the pleura measuring 4.7 x 4.9 x 3.2 cm. There may be extra pleural extension; however, no definite osseous destruction is visualized. There is a 14 x 10 mm left supraclavicular lymph node (image 3) and a left suprahilar node that measures 19 x 11 mm (image 5). There is no contralateral mediastinal or right-sided hilar adenopathy. These findings are within a background of apical-predominant paraseptal emphysema.
影像表現(xiàn)：
胸片：胸部正位片示左肺尖陰影。
胸部CT掃描：增強(qiáng)掃描示左肺尖胸膜下腫物，大小約4.7 x 4.9 x 3.2 cm，中心壞死，周圍可見毛刺；病變侵犯至胸膜外，未見明顯骨質(zhì)破壞。左鎖骨上及左上肺門分別見14 x 10 mm、19 x 11 mm增大淋巴結(jié)。對側(cè)縱隔及右肺門未見腫大淋巴結(jié)。肺尖可見多發(fā)小葉間隔旁肺氣腫。
Differential diagnosis
Pancoast tumor
Pulmonary metastasis
Pleural metastasis
Mesothelioma
Lymphoma
Tuberculosis
Nocardiosis
Actinomycosis
鑒別診斷：
肺上溝癌
肺轉(zhuǎn)移瘤
胸膜轉(zhuǎn)移
間皮瘤
淋巴瘤
結(jié)核
諾卡氏菌病
放射菌病
Diagnosis: Pancoast tumor -- primary bronchogenic carcinoma
診斷：Pancoast瘤（原發(fā)性支氣管肺癌）
Pancoast tumors
Pathophysiology
Pancoast tumors are also referred to as superior sulcal tumors. This term is often reserved for bronchogenic carcinomas. The name is derived from their association with Pancoast syndrome, which results when the tumor involves the brachial plexus and sympathetic chain. Pancoast syndrome consists of shoulder pain, Horner syndrome, and C8-T2 radicular pain.
病理生理學(xué)：Pancoast瘤，也稱作肺上鉤癌，一般為支氣管肺癌。因Pancoast綜合征而得名，腫瘤累及臂叢神經(jīng)及交感鏈。Pancoast綜合征包括：肩部疼痛、霍納綜合征、C8-T2神經(jīng)根痛。
Epidemiology
Pancoast tumors account for 3% to 5% of all bronchogenic carcinomas. Most affected patients are between 50 and 60 years. Men are more commonly affected than women. Risk factors include smoking, asbestos exposure, and exposure to industrial elements.
流行病學(xué)：Pancoast瘤占所有支氣管肺癌的3-5%，好發(fā)年齡位于50-60歲，男性多于女性。危險(xiǎn)因素包括吸煙、石棉接觸、暴露于工業(yè)環(huán)境。
Clinical presentation
Patients present with symptoms of Pancoast syndrome: shoulder pain, Horner syndrome, and C8-T2 radicular pain. Patients may also have upper arm edema, secondary to subclavian vein occlusion.
臨床表現(xiàn)：患者主要表現(xiàn)為Pancoast綜合征：肩部疼痛、霍納綜合征、C8-T2神經(jīng)根痛。也可因鎖骨下靜脈閉塞表現(xiàn)為上臂水腫。
Imaging features
Plain radiograph: Plain films reveal an opacity at the apex of the lungs in approximately two-thirds of cases. Some films will reveal an asymmetric unilateral apical cap. There can be rib involvement or extension into the supraclavicular fossa.
CT: Nonenhanced CT can be used to confirm the presence of a mass. Additionally, it can be used to assess skeletal involvement. Metastatic disease to the lungs, pleura, chest wall, and upper abdomen can be limitedly evaluated via noncontrast scan. Contrast-enhanced CT is useful to evaluate vascular involvement and node size/involvement.
PET/CT: Uptake on PET/CT can be used to evaluate the primary neoplasm, lymph node metastases, and distant metastases.
MRI: MRI is useful to evaluate the soft-tissue involvement of Pancoast involvement, especially the brachial plexus.
影像表現(xiàn)：
平片：約2/3的病例表現(xiàn)為肺尖陰影，部分表現(xiàn)為一側(cè)肺尖形態(tài)不規(guī)則，可見肋骨受累，病變上凸至鎖骨上窩。
CT：平掃可明確有無腫物，骨質(zhì)結(jié)構(gòu)有無受累，對于評(píng)價(jià)肺內(nèi)、胸膜、胸壁、上腹部有無轉(zhuǎn)移有一定限度。增強(qiáng)掃描可評(píng)估血管受累及淋巴結(jié)轉(zhuǎn)移情況。
PET/CT：原發(fā)腫瘤、淋巴結(jié)轉(zhuǎn)移及遠(yuǎn)處轉(zhuǎn)移灶有攝取。
MRI：可用于評(píng)估臂叢神經(jīng)有無受累。
Treatment
Treatment of Pancoast tumor is largely dependent on the stage of the cancer and the involvement of the apex, including soft-tissue structures such as nerves and vessels. If there is involvement of the brachial plexus and subclavian vessels, chemoradiation is often used to down grade the tumor to increase the probability of resection.
治療：
Pancoast瘤的治療主要根據(jù)腫瘤的分期及局部受累（血管、神經(jīng)）的情況而定。如果腫瘤侵犯臂叢神經(jīng)及鎖骨下血管，通常借助預(yù)先的放化療來降低腫瘤分級(jí)來增加可切除率。
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