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Case Report
Shoulder and arm pain: A “red herring” chief complaint in a smoker diagnosed with Pancoast-Tobías syndrome
1 MD, Department of Community Health and Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
2 MD, Department of Anesthesia and Intensive Care, Bustamante Hospital for Children, Kingston, Jamaica
3 MD, National Blood Transfusion Services, Kingston, Jamaica
4 MD, Independent Researcher, Fort Worth, TX 76104, USA
5 MD, Department of Emergency Medicine, The University Hospital of the West Indies, Kingston 7, Jamaica
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Chadane Thompson
MD, Department of Community Health and Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston 7,
Jamaica
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Article ID: 100127Z10CT2024
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Thompson C, Daley R, Fullerton S, Lambert-Johnson S, Johnson DK. Shoulder and arm pain: A “red herring” chief complaint in a smoker diagnosed with Pancoast-Tobías syndrome. J Case Rep Images Oncology 2024;10(1):1–6.ABSTRACT
Introduction: A Pancoast tumor is a rare apical lung cancer that can lead to a constellation of signs and symptoms known as Pancoast-Tobías syndrome, which involves ipsilateral shoulder and arm pain, Horner’s syndrome, and atrophy of the intrinsic hand muscles. As a Pancoast tumor progresses, it first invades the brachial plexus and causes unrelenting shoulder and arm pain in the C8-T2 nerve distributions. However, when evaluating this presenting symptom, it is often considered benign, especially in aging patients. Consequently, Pancoast-Tobías syndrome is easily misdiagnosed or delayed in diagnosis, resulting in poor prognosis, particularly for patients with advanced disease.
Case Report: We present the case of an elderly Afro-Caribbean woman with a 24-pack-year smoking history who presented with unrelenting pain to the right shoulder and arm for two months. During that time, she visited multiple family physicians. Onset of pain coincided with a wasp sting that was complicated by a large local reaction. Despite clinical resolution of the inflammatory reaction, the pain persisted even with multi-modal oral analgesics. Detailed physical examination later revealed ipsilateral atrophy of the intrinsic hand muscles and focal chest findings concerning for an underlying consolidative lung process. This prompted diagnostic chest imaging, which identified a right-sided Pancoast tumor aggressively invading adjacent structures. She soon developed Horner’s syndrome, resulting in clinicoradiologic confirmation of Pancoast-Tobías syndrome.
Conclusion: It is important to consider Pancoast-Tobías syndrome as an important differential of unrelenting shoulder and arm pain, even in the absence of pulmonary symptoms, in patients with risk factors for lung cancer, such as chronic smokers.
Keywords: Arm pain, Lung cancer, Palliative care, Pancoast-Tobías syndrome, Pancoast tumor, Shoulder pain, Smoker
SUPPORTING INFORMATION
Author Contributions
Chadane Thompson - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rebecca Daley - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sidni Fullerton - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shana-Kay Lambert-Johnson - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Donahue Krisstoff Johnson - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from a legally authorized representative for anonymized patient information to be published in this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Chadane Thompson et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
