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A smoker with an apical mass
  1. T M O’Connor1,
  2. M Casey2,
  3. T Aherne3,
  4. C P Bredin1
  1. 1Cork University Hospital, Cork, Ireland: Department of Respiratory Medicine
  2. 2Department of Radiology
  3. 3Department of Cardiothoracic Surgery
  1. Correspondence to:
 Dr T M O’ Connor, Department of Respiratory Medicine, St Vincent’s University Hospital, Elm Park, Dublin 4, Republic of Ireland;
 terryoconnor{at}eircom.net

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Answers on p 633.

A 60 year old woman presented with a two year history of intermittent stabbing pain at her right scapula, radiating to her right upper limb. The pain was increasing in frequency, had no obvious precipitants, and was unaffected by coughing or deep inspiration. She denied dyspnoea, cough, sputum, haemoptysis, or fever. She had smoked 10 cigarettes per day for 20 years.

Physical examination was normal. A chest radiograph (fig 1 ) demonstrated a well defined soft tissue mass at the right apex. Fibreoptic bronchoscopy was normal. Based on the radiological appearances of the lesion on computed tomography and magnetic resonance imaging (MRI) (figs 2 and 3), a definitive procedure was performed.

Figure 1

Posteroanterior chest radiograph showing right apical soft tissue mass.

Figure 2

Computed tomogram of chest.

QUESTIONS

  1. Describe the abnormalities shown in figs 2 and 3.

  2. What is the differential diagnosis?

  3. What was the definitive procedure?

  4. Based on the radiological appearances, what potential complication might arise if the lesion was left untreated?

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