An unusual but classic cause of hand numbness: Pancoast tumour

A 56-year-old man with a 42-pack year smoking history presented with complaints of acute-onset left shoulder pain, weakness and numbness of the left hand. A chest X-ray examination revealed a large apical opacity with complete destruction of first, second and third left ribs (figure 1), which was then confirmed with a chest CT scan (figure 2), which showed a large apical 9 cm heterogeneous mass together with destruction of left first to third ribs and subclavian artery involvement. Transthoracic needle biopsy was then performed which showed poorly differentiated squamous cell carcinoma of the lung. The patient was discharged to follow-up with oncology to initiate chemoradiation therapy.

Pancoast tumours, first described by Henry K Pancoast in 1924, are a rare subtype of apical lung tumours at the superior thoracic outlet and comprise <5% of all lung cancers. The clinical constellation of shoulder and arm pain, along the distribution of the eighth cervical nerve trunk...

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