Pancoast Tumor Presenting as Neck Pain in the Chiropractic Office

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A 59-year-old Asian man presented to a chiropractor in Hong Kong with a 1-month history of neck and shoul- der pain and numbness that had been treated unsuccessfully with exercise, medications, and acupuncture. He had an active history of tuberculosis, which was currently treated with antibiotics, and a 50-pack-year history of smoking. Cervical magnetic resonance imaging (MRI) was performed urgently, revealing a small cervical disc herniation thought to correspond with radicular symptoms. However, as the patient did not respond to a brief trial of care, a thoracic MRI was urgently ordered, revealing a large superior sulcus tumor invading the upper to mid-thoracic spine. The patient was referred for medical care and received radiotherapy and chemothera- py with a positive outcome. A literature review identified 6 previously published cases in which a patient pre- sented to a chiropractor with an undiagnosed Pancoast tumor. All patients had shoulder, spine, and/or upper extremity pain.

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