A 59-year-old male smoker with COPD (FEV1 32% predicted) presents with acute severe left shoulder pain radiating down the medial arm. Vital signs: BP 158/92, HR 104, RR 22, SpO2 88% on home oxygen. Examination reveals ipsilateral ptosis, miosis, and anhidrosis. Chest X-ray shows left apical opacity. He denies recent trauma or chest tube placement. Which of the following is the most likely location of the underlying lesion?
- A)Lower lobe adjacent to the diaphragm
- B)Mainstem bronchus near the carina
- C)Posterior mediastinum adjacent to the esophagus
- D)Pleural space surrounding the entire lung
- E)Superior pulmonary sulcus at the lung apexGABARITO
Explicação
Superior pulmonary sulcus at the lung apex is correct. A Pancoast tumor at the lung apex can invade the brachial plexus and cervical sympathetic chain, causing shoulder and arm pain together with Horner syndrome. The smoking history supports an apical bronchog... Ver explicação completa e trilha adaptativa →