A 72-year-old woman is brought to the emergency department because of lethargy and weakness for the past 5 days. During this period, she has had a headache that worsens when she leans forward or lies down. Her arms and face have appeared swollen over the past 2 weeks. She has a history of hypertension, gastroesophageal reflux disease, and osteoarthritis. She has smoked two packs of cigarettes daily for 40 years. Her temperature is 37.2°C (99°F), pulse is 103/min, and blood pressure is 98/56 mm Hg. Examination shows jugular venous distention, and engorged veins on the anterior chest wall. There is no axillary or cervical lymphadenopathy. There is 1+ pitting edema in both arms. Which of the following is the most likely cause of this patient's symptoms?

Question

A 72-year-old woman is brought to the emergency department because of lethargy and weakness for the past 5 days. During this period, she has had a headache that worsens when she leans forward or lies down. Her arms and face have appeared swollen over the past 2 weeks. She has a history of hypertension, gastroesophageal reflux disease, and osteoarthritis.  She has smoked two packs of cigarettes daily for 40 years. Her temperature is 37.2°C (99°F), pulse is 103/min, and blood pressure is 98/56 mm Hg. Examination shows jugular venous distention, and engorged veins on the anterior chest wall. There is no axillary or cervical lymphadenopathy. There is 1+ pitting edema in both arms. Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

Eductional Objective: Tumors located in the lung apex (superior sulcus) are called Pancoast tumors.  Invasion of surrounding structures can lead to ipsilateral Horner syndrome, rib destruction, atrophy of hand muscles, and pain in the distribution of C8, T1, and T2 nerve roots.

A 72-Year-Old Woman Is Brought to the Emergency Department Because