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J Thorac Cardiovasc Surg 2006;132:183-184
© 2006 The American Association for Thoracic Surgery

Brief Communication

Methicillin-resistant Staphylococcus aureus infection causing Pancoast syndrome

Hon Chi Suen, MD a , * , Richard A. Summa, MD b , Alexander Babich, MD c , Edwin C. Ernst, MD d , Phillip Zinser, MD e , Wilfrido C. Feliciano, MD f , John H. Rice, MD g

a Department of Cardiothoracic Surgery, DePaul Health Center, St Louis, MO
b Department of Pulmonology, DePaul Health Center, St Louis, MO
c Department of Pathology, DePaul Health Center, St Louis, MO
d Department of Radiology, DePaul Health Center, St Louis, MO
e Department of Infectious Disease, DePaul Health Center, St Louis, MO
f Department of Plastic Surgery, DePaul Health Center, St Louis, MO
g Department of Internal Medicine, DePaul Health Center, St Louis, MO

Received for publication January 18, 2006; accepted for publication February 8, 2006.

* Address for reprints: Hon Chi Suen, MD, Cardiothoracic Surgery Associates, SC, 12B Park Place, Swansea, IL 62226. (Email: HSUEN@earthlink.net).

The first 20% of the full text of this article appears below.


Figure 1
Dr Suen


Infectious causes of Pancoast syndrome have been described. We present the first case report of methicillin-resistant Staphylococcus aureus (MRSA) pulmonary abscess with osteomyelitis of the first rib mimicking a Pancoast tumor in a non-immunocompromised young man.

Clinical Summary

A 41-year-old African American man reported right shoulder pain radiating down the right arm for 3 months. Examination revealed a well-built person with no positive physical findings. Chest radiography was unremarkable, but a computed tomography chest showed a 3-cm mass abutting the right first rib, right internal thoracic artery, and right brachiocephalic vein (Figure 1). There was no enlarged mediastinal lymph node. Positron emission tomography scan showed intense activity in the mass. Bone scan showed increased activity in the right first rib suggesting lytic changes. Magnetic resonance imaging of the chest confirmed chest wall invasion without vascular or brachial plexus involvement. The findings were indicative of a Pancoast tumor. The initial plan was to confirm malignancy . . . [Full Text of this Article]






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