Does apical calcified granuloma in chest x-ray indicate a Pancoast tumor?

Q. Are my shoulder blade pain and pain under the ribs a sign of a pancoast tumor?

Answered by
Dr. Muhammad Zubayer Alam
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 07, 2021 and last reviewed on: Jul 17, 2023

Hello doctor,

I have been having pain in my shoulder blade and under my ribs for the past nine months. Physiotherapy and chiro therapy did not help. And my x-ray showed an apical calcified granuloma in the left lung. Could this be a pancoast tumor? Thanks.



Welcome to Thank you for the query. I can understand your concern. According to your statement, you have been suffering from pain in the shoulder blade and under ribs for the last nine months. Your x-ray shows (attachments removed to protect the patient’s identity) subsegmental atelectasis and left apical calcified granuloma measuring 4 mm. Subsegmental atelectasis usually affects less than one bronchopulmonary segment, and it is the mildest form of atelectasis. It does not cause significant loss of lung volume. It is caused due to obstruction of a small bronchus due to hypoventilation, pulmonary embolism, or lower respiratory tract infections. A granuloma is a small area of inflammation that are benign. Again calcified granuloma may result from inflammatory conditions like sarcoidosis, tuberculosis, and fungal infections like histoplasmosis. Without symptoms, granuloma does not need any further treatment or even follow-up imaging tests. In the case of Pancoast tumor, radiological findings may demonstrate a soft tissue opacity at the apex of the lung with or without ribs involvement or extension into the supraclavicular fossa. So, according to your radiological report, it does not suggest the presence of a Pancoast tumor. So, do not worry. Take care.

Hello doctor,

Thanks for the reply. Are my shoulder blade pain and rib cage pain symptoms of pancoast tumor? Should I do an magnetic resonance imaging (MRI) or positron emission tomography (PET) scan? Could it be a metastasis from another area? Thanks.



Welcome back to Yes, your concern is right. Shoulder blade pain and rib cage pain are the initial symptoms of a Pancoast tumor. But, your x-ray report does not indicate the presence of a Pancoast tumor or a soft tissue opacity at the apex of the lungs. In such a case, MRI (magnetic resonance imaging) is the standard test for excluding Pancoast tumors. It may be a metastasis from another area, but without undergoing some specific investigations, it is totally difficult to predict. In case of any carcinoma and its metastasis, someone will lose appetite, significant weight loss, night sweats, prolonged fever, malaise, fatigue, weakness, joint pain, and many more. I think you are not suffering from such type of symptoms or complications. Pancoast tumor may develop some clinical features such as swelling in the arm, chest tightness, cough, respiratory discomfort, weakness in the hand muscles, numbness or tingling sensation in hand, muscle wasting in the arm or hand, fatigue, significant weight loss, drooping eyelids, constrict pupils, absence of sweating, enophthalmos, or displaced eyeballs. Again, shoulder blade pain and rib cage pain may also result from other underlying health conditions such as costochondritis, cervical disc herniation, poor posture, overused muscles, thoracic outlet obstruction, etc. Any trauma, injury, or painful conditions in the shoulder blade may radiate to the rib cage as the shoulder blade is connected with the rib cage. So, you can also undergo an x-ray or MRI of the cervical spine to exclude cervical degenerative changes or cervical disc herniation. Take care.

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