Chest X-ray - Scenario 1
Scenario discussion

Scenario discussion

Poor candidate

  • Spends too long considering patient rotation
  • Does not notice volume loss of the left lung

Average candidate

  • Demonstrates systematic approach
  • Mentions consolidation and suggests 'Pancoast tumour'

Good candidate

  • 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

Pancoast tumour

  • 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).

Descriptive terms

  • 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.

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: February 2016