A 68-year-old smoker presents with right shoulder and arm pain. Chest X-ray shows a right apical opacity with destruction of the first and second ribs. Which diagnosis is most likely?

• A Tuberculous osteomyelitis
• B Apical pleural plaque
• C Cervical rib
• D Pancoast tumour ✓

Explanation

D Pancoast tumour (superior sulcus tumour) classically presents with shoulder and arm pain due to invasion of the brachial plexus, with apical opacity and rib destruction on chest X-ray. Apical pleural plaques do not destroy bone. D cervical rib is congenital and painless. Tuberculous osteomyelitis is rare in ribs and lacks a mass.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.