Pancoast tumour in a 62-year-old smoker: Differentiating malignancy from cardiac emergency and tuberculosis
Abstract
English:
Introduction
Pancoast tumours account for approximately 3%–5% of lung cancers. Their atypical presentation often mimics cardiovascular, neurological or infectious conditions, particularly in tuberculosis-endemic regions, leading to delays in diagnosis and treatment.
Case Presentation
A 62-year-old male smoker presented with progressive, severe left-sided chest pain radiating to the back, scapula, neck and left upper extremity, accompanied by paraesthesia and reduced grip strength. The pain led to an initial evaluation for acute coronary syndrome and pulmonary tuberculosis. Electrocardiography showed no ischaemic changes, and sputum testing for Mycobacterium tuberculosis was negative. Chest radiography and contrast-enhanced thoracic computed tomography demonstrated a solid apical mass invading the chest wall and adjacent soft tissues, consistent with a Pancoast tumour. Neurological findings suggested lower brachial plexus involvement without Horner’s syndrome. Histopathological assessment confirmed adenosquamous cell carcinoma of the lung.
Discussion
This case highlights the diagnostic complexity of Pancoast tumours, which may present without prominent respiratory symptoms and instead mimic cardiac emergencies or endemic infections such as tuberculosis. Neurological deficits helped localise tumour invasion, highlighting the importance of thorough neurological assessment and early imaging.
Conclusions
Early recognition of atypical Pancoast tumour presentations is essential to prevent diagnostic delay and neurological deterioration, particularly in tuberculosis-endemic settings.
© 2026 Steven Alvianto, Hendrawan Chandra Kusuma, Dean Ascha Wijaya, Elaine Purnomo, Eva Lydia Munthe, Budhi Hartoko, Nelly, published by Romanian Society of Pneumology
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