Pancoast Syndrome Differential Diagnoses

Updated: Nov 21, 2019
  • Author: Karl J D'Silva, MD; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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DDx

Diagnostic Considerations

A major issue with Pancoast syndrome is the potential for a delayed diagnosis. The apical lung cancer may not be visualized on an initial chest radiograph, and by the time the patient presents with symptoms, the tumor has almost always invaded nearby structures. In addition, the symptoms produced by the disorder can be mimicked by numerous neurologic or musculoskeletal disorders, thus delaying diagnosis.

Differential diagnoses of masses in the apical chest include the following:

  • Primary tumors of the thyroid, larynx, and pleura
  • Infectious disorders of the lung
  • Aneurysms of the subclavian vessels
  • Amyloid of pleura
  • Multiple myeloma

The differential diagnoses of arm and shoulder pain are extensive; however, the primary conditions that must be excluded are thoracic outlet syndrome and cervical disk disease, which are commonly mistaken for Pancoast syndrome in the early clinical course. Careful neurologic examination, electromyographic studies, and ulnar nerve studies must be performed to verify the precise diagnosis.

Differential Diagnoses