An apical lung tumor, also known as a Pancoast tumor, may invade local neural structures and produce a characteristic syndrome of pain and possible Horner's syndrome. Horner's syndrome may occur with a Pancoast tumor or whenever a tumor impinges on the sympathetic chain. The thoracic manifestations of metastatic lung cancer result from hematogenous, lymphatic or intra-alveolar tumor dissemination. Detecting these nodal and distant metastases is essential in properly staging the patient. Lung cancers may involve any of the normal chest structures.
Pericardial involvement is more common than myocardial involvement.
Pericardial involvement causes pericardial effusions, tamponade, or dysrhythmias, and is suggested by an enlarging heart silhouette on chest x-ray, by a paradoxical pulse, by a pericardial friction rub or Kussmaul's sign, by new congestive failure or by venous engorgement. The diagnosis is confirmed using echocardiography. Common symptoms of pleural involvement are dyspnea, cough and chest pain. Pleural involvement manifests as pleural effusions, pleural masses or rarely pneumothorax. Pleural effusion from lung cancer can arise because of lymphatic obstruction or due to direct pleural invasion by the tumor.