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• W4387248907 abstract "SESSION TITLE: Lung Cancer Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Horner syndrome is a rare neurological disorder caused by damage to the sympathetic nerve pathway, which is characterized by a triad of ipsilateral ptosis, miosis, and anhidrosis. These symptoms can result from various etiologies, including trauma, infection, and neoplastic processes. We present a case of Horner syndrome in a 59-year-old woman with a lung mass. This case report aims to increase awareness and understanding of Horner syndrome and the importance of prompt management. CASE PRESENTATION: A 59-year-old woman with a history of hypertension and hyperlipidemia presented with a persistent cough for two months. She reported dyspnea, chest pain, disequilibrium, mild memory loss, confusion, dysphagia, left arm numbness, and unintentional weight loss of 18 lbs over the past two months. Her family noticed drooping of her left eyelid that had worsened. Physical examination revealed ptosis and miosis in the left eye, diminished breath sounds in the left upper lung field, a positive Romberg sign with an unstable wide-based gait, and oxygen saturation of 87% on room air. A chest CT scan revealed an invasive mass measuring 11x11x12 cm within the apex of the left upper lobe, with invasion to the apical chest wall and mediastinal structures, including the pulmonary artery, vein, left subclavian artery, esophagus, and trachea with rightward deviation. The patient's presentation of Horner's syndrome was concerning for brachial plexus involvement. EBUS later revealed a markedly narrowed left upper bronchus and transbronchial needle aspiration revealed squamous cell carcinoma in the left upper lobe. A PET scan revealed moderate to intense uptake throughout the spine and hepatic dome. The patient was referred to general surgery for PEG tube placement due to dysphagia, and a brain MRI was ordered. Unfortunately, the patient passed away before further diagnosis and management were provided. DISCUSSION: Horner's syndrome is caused by disruption of the sympathetic nerve pathway, which can occur at various levels, including the hypothalamus, spinal cord, and nerve fibers. It can be largely divided into two types: preganglionic and postganglionic syndrome. Preganglionic fibers exit at T1 level of the spinal cord and arch over the apex of the lung to enter cervical sympathetic chain. Postganglionic fibers follow the external carotid artery and innervates the sweat glands and blood vessels of the face while the remaining fibers travel with cranial nerves in cavernous sinus. Preganglionic syndrome is often related to malignancy and is accompanied by ipsilateral arm pain, like in this case. Postganglionic syndrome is often caused by internal carotid dissection, cavernous sinus aneurysm, or benign neck mass. CONCLUSIONS: This case report highlights the importance of recognizing Horner's syndrome as a clinical clue for identifying a Pancoast lung tumor. The prompt recognition of the triad may accelerate identifying the underlying diagnosis and thus delivery of better clinical outcomes. REFERENCE #1: Lee JH, Lee HK, Lee DH, Choi CG, Kim SJ, Suh DC. Neuroimaging strategies for three types of Horner syndrome with emphasis on anatomic location. AJR Am J Roentgenol. 2007 Jan;188(1):W74-81. doi: 10.2214/AJR.05.1588. PMID: 17179330. REFERENCE #2: Maloney WF, Younge BR, Moyer NJ. Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Am J Ophthalmol. 1980 Sep;90(3):394-402. doi: 10.1016/s0002-9394(14)74924-4. PMID: 7425056. DISCLOSURES: No relevant relationships by Fahid Alghanim No relevant relationships by William Arvan No relevant relationships by David Baik" @default.
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• W4387248907 date "2023-10-01" @default.
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• W4387248907 title "HORNER SYNDROME AS A LATE MANIFESTATION OF NON-SMALL CELL LUNG CANCER" @default.
• W4387248907 doi "https://doi.org/10.1016/j.chest.2023.07.2900" @default.
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