What question did this study set out to answer?

The aim is to highlight Pancoast syndrome as a rare presentation of MSSA lung abscess, often confused with malignancy.

May 20, 2026

B71-09 Pancoast Syndrome Caused by MSSA Lung Abscess: A Rare Mimicker of Malignancy

Key Points

The aim is to highlight Pancoast syndrome as a rare presentation of MSSA lung abscess, often confused with malignancy.
Case report of a 57-year-old male with symptoms and imaging suggestive of malignancy.
Investigation included blood cultures, chest CT imaging, and interventional biopsy for diagnosis.
Treatment involved prolonged intravenous antibiotics based on the microorganism identified.
Positive blood culture for MSSA ultimately diagnosed the infectious process.
Imaging showed an apical lesion causing symptoms, initially suggestive of malignancy.
Completion of IV antibiotics led to improvement in imaging findings and resolution of symptoms.

Abstract

Abstract Pancoast syndrome is classically associated with superior sulcus tumors, primarily non-small cell lung carcinoma. Infectious causes are rare and can pose significant diagnostic challenges. We present a case of a 57-year-old male with a history of high blood pressure and past surgeries involving the left hip, right knee, and third finger of the left hand presents to the emergency room with neck and shoulder pain, headache, productive cough, general malaise, and fever. He denies chest pain, palpitations, or chills. Vital signs with fever, tachycardic with adequate pulse oxygenation. Physical examination pertinent for right sided neck fullness and redness with associated tachycardia with regular heart rhythm. Laboratories with elevated white blood cells (20.58) with left shifting, thrombocytosis, hyponatremia (129), hypochloremia (89). Inflammatory markers elevated including procalcitonin (1.47), CRP (2.2) and ESR greater than 140. Started on broad spectrum antibiotics with piperacillin/tazobactam and linezolid. Chest CT imaging was performed and noted with right sided indeterminate round apical density measuring 3.3 x 4.2 cm which may partially related to a thrombosed brachiocephalic trunk/SVC. Lesion appears to extend into the adjacent soft tissues of the right sternoclavicular joint causing subluxation. These findings were suggestive of a Pancoast tumor causing SVC obstruction. Interventional radiology biopsy was done with evidence of necrotic debris with scattered neutrophils most consistent with abscess. Negative for neoplastic process. Blood culture was ordered and found positive for MSSA. 2D echocardiogram negative. HIV, hepatitis and rheumatologic workup negative. The patient completed IV antibiotics with follow up imaging showing improvement of lesion and resolution in symptomatology. Radiologic findings of an apical lesion with soft tissue invasion strongly suggest malignancy, often delaying diagnosis. Given the therapeutic and prognostic divergence from malignant superior sulcus tumors, maintaining a high index of suspicion for treatable infectious causes — particularly in patients with febrile illness, systemic inflammatory markers, recent bacteremia, immunosuppression, or imaging features suggestive of abscess/necrosis — is essential. Treatment requires prolonged intravenous antibiotics (at least 4-6 weeks). Early recognition prevents unnecessary invasive procedures for presumed cancer. This abstract is funded by: None

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