Munir Mian, Jamil Saad Bin, Rehmani Sameerah, Borz-Baba Carolina
Internal Medicine, Saint Mary's Hospital's Internal Medicine Residency Program, Waterbury, USA.
Hospitalist Medicine/Internal Medicine, Saint Mary's Hospital, Waterbury, USA.
Cureus. 2021 Feb 3;13(2):e13112. doi: 10.7759/cureus.13112.
A 65-year-old man with 50 pack-year smoking history presented to the emergency department for evaluation of upper back and right shoulder pain secondary to a fall. Physical examination was notable for anisocoria with a constricted left pupil (miosis), mild ptosis of the left eyelid, and bilateral shoulder pain, right more than left, with both passive and active movements. Chest computed tomography identified a soft tissue mass at the left lung apex with extension into the pleural surface, associated with destructive osseous changes of the right scapula, adjacent ribs, and thoracic vertebral bodies. Imaging of the brain revealed multiple masses suspicious of metastatic brain lesions. Biopsy of the right supraclavicular lymph node revealed lung tissue adenocarcinoma and negative Kirsten rat sarcoma viral oncogene homolog (K-Ras), epidermal growth factor receptor (EGFR), B-raf proto-oncogene (BRAF), C-ros oncogene 1 (ROS1), and anaplastic lymphoma kinase (ALK) rearrangement. Recognizing Pancoast syndrome in patients with significant smoking history, anisocoria, and shoulder pain is crucial for identifying the underlying etiology and expediting the treatment.
一名有50年吸烟史、65岁的男性因跌倒后出现上背部和右肩疼痛而到急诊科就诊。体格检查发现有不等大瞳孔，左侧瞳孔缩小（瞳孔缩小），左侧眼睑轻度下垂，双侧肩部疼痛，右侧比左侧更明显，被动和主动活动时均有疼痛。胸部计算机断层扫描显示左肺尖有一个软组织肿块，延伸至胸膜表面，伴有右肩胛骨、相邻肋骨和胸椎椎体的骨质破坏改变。脑部成像显示多个肿块，怀疑为脑转移瘤。右锁骨上淋巴结活检显示肺组织腺癌， Kirsten大鼠肉瘤病毒癌基因同源物（K-Ras）、表皮生长因子受体（EGFR）、B-raf原癌基因（BRAF）、C-ros癌基因1（ROS1）和间变性淋巴瘤激酶（ALK）重排均为阴性。对于有大量吸烟史、不等大瞳孔和肩痛的患者，认识到潘科斯特综合征对于识别潜在病因和加快治疗至关重要。
