9th January 2024

Respiratory

Common symptoms include:

• Cough, which may be productive of sputum
• Haemoptysis
• Chest pain, which may be pleuritic
• Dyspnoea
• Hoarseness of voice

Dyspnoea may be related to obstruction of the airways, reduced capacity of the lung parenchyma, or from phrenic nerve involvement. An exudative pleural effusion can occur, which is usually unilateral.

The recurrent laryngeal nerve can be compressed by a tumour if in the apex, causing a hoarse voice as part of Horner’s syndrome. A tumour which grows from the apex of the lung is called a Pancoast tumour. Other features of Horner’s include miosis, partial ptosis, anhidrosis and a thoracic outlet syndrome, with pain and weakness in the ipsilateral upper limb.

Superior vena cava (SVC) syndrome may result from compression of the SVC by a tumour. This results in facial oedema, venous distension observed in the chest and upper limbs, along with dyspnoea and a headache. Pemberton’s sign can be seen in SVC syndrome, where elevation of both arms for around one minute causes/worsens facial oedema.