Chest imaging: Pancoast tumour: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Chest imaging: Pancoast tumour

Sample item

A smoker with shoulder pain, Horner syndrome and weakness of the intrinsic hand muscles has a chest radiograph showing an apical cap opacity with rib destruction. What is the best next imaging test to assess local invasion?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. MRI of the thoracic inlet

A Pancoast (superior sulcus) tumour invades the brachial plexus, subclavian vessels and vertebrae, and MRI with sagittal and coronal planes defines this extent. CT assesses bone destruction. Biopsy provides tissue diagnosis.

Option by option

  • A. MRI of the thoracic inlet (correct)

    Correct. MRI best shows brachial plexus and vascular invasion.

  • B. Ultrasound of the neck

    Ultrasound cannot assess the apex behind bone.

  • C. Barium swallow

    Barium swallow evaluates the oesophagus.

  • D. Mammography

    Mammography is for the breast.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, MRI of the thoracic inlet. A Pancoast (superior sulcus) tumour invades the brachial plexus, subclavian vessels and vertebrae, and MRI with sagittal and coronal planes defines this extent.

Why is "Ultrasound of the neck" not the answer?

Ultrasound cannot assess the apex behind bone.

Why is "Barium swallow" not the answer?

Barium swallow evaluates the oesophagus.

Why is "Mammography" not the answer?

Mammography is for the breast.

What concept does this question test?

It tests Chest imaging: Pancoast tumour in Radiology. CT assesses bone destruction. Biopsy provides tissue diagnosis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chest imaging: Pancoast tumour?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.