Pancoast tumor (superior sulcus tumor) invades the brachial plexus and stellate ganglion. Which specific neurological finding results from stellate ganglion involvement?

• A Horner syndrome (ptosis, miosis, anhidrosis, enophthalmos) ✓
• B Wrist drop due to radial nerve invasion
• C Recurrent laryngeal nerve palsy causing hoarseness
• D Phrenic nerve palsy causing ipsilateral diaphragmatic paralysis

Explanation

The stellate ganglion (cervicothoracic ganglion) is the superior sympathetic ganglion of the thorax, located anterior to the C7-T1 vertebrae. Pancoast tumors arising at the lung apex invade it, interrupting the sympathetic pathway to the face and eye, causing ipsilateral Horner syndrome: ptosis (superior tarsal muscle paresis), miosis (dilator pupillae paresis), anhidrosis (ipsilateral face, due to sweat gland sympathetic denervation), and apparent enophthalmos (due to inferior tarsal muscle paresis). Brachial plexus invasion (C8-T1) also causes ulnar distribution pain and weakness, but Horner is from stellate ganglion.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.