Spends too long considering patient rotation
Does not notice volume loss of the left lung
Demonstrates systematic approach
Mentions consolidation and suggests 'Pancoast tumour'
Comments on soft tissue swelling
Explains all physical signs and symptoms
Links the findings to the clinical features before being asked, commenting on 'Pancoast tumour' and its features
Apical lung malignancies can invade surrounding soft tissue structures such as nerves of the brachial plexus (arm pain), the recurrent laryngeal nerve (hoarse voice), the phrenic nerve (diaphragm/phrenic palsy) and the sympathetic supply to the eye(Horner's syndrome).
The terms 'mass,' 'lung shadowing,' 'opacification,' 'increased density' and 'consolidation' are all acceptable terms to describe the apical abnormality. Remember that 'consolidation' does not only imply infection and is a descriptive term that can also refer to tumour, haemorrhage or pulmonary oedema.
An apical bronchogenic carcinoma was confirmed at CT and biopsy.