Pancoast–Tobias Syndrome with Horner Syndrome as a Red Flag in Chronic Shoulder Pain: A Case Report

• Arlyndelia Alfitri Haryadi

• Firda Judith Nurrahmah

• Seftia Yolanda

• Selma Christalia Hestining Prasetya

• Dian Lulu

Introduction: A Pancoast tumor, also known as a superior sulcus tumor, is a lung malignancy located at the apex that frequently involves structures of the thoracic inlet and is generally classified as non-small cell lung cancer (NSCLC). Case Illustration: A 41-year-old man presented with worsening shortness of breath. Three months prior, the patient experienced pain in his left shoulder radiating down his arm to his little finger. These symptoms were accompanied by numbness and weakness in the left upper extremity, as well as hoarseness. One month prior to hospitalization, ptosis, miosis, and anhidrosis developed on the left side of the face. The patient also experienced a 10-kg weight loss over 3 months, with a history of smoking (Brinkman Index 1120). Physical examination revealed Horner’s syndrome, a neurological deficit in the ulnar distribution, and decreased lung expansion and breath sounds at the left lung apex. A chest X-ray showed a large mass at the left lung apex with rib destruction. A chest CT scan revealed an inhomogeneous mass measuring approximately 15 cm with invasion of surrounding structures and tracheal deviation. These findings pointed to a Pancoast tumor. Discussion: Shoulder pain radiating to the C8–T1 distribution accompanied by neurological deficits indicates involvement of the inferior brachial plexus. Horner’s syndrome reflects invasion of the cervical sympathetic chain. The combination of these findings is characteristic of advanced-stage Pancoast tumors. Radiological and cytological findings support a diagnosis of non-small cell lung cancer (NSCLC). Conclusion: A Pancoast tumor should be suspected in patients with shoulder pain radiating to the arm accompanied by neurological deficits and Horner’s syndrome. Diagnosis requires clinical and radiological correlation, as well as histopathological confirmation, for appropriate management.

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