CTICasesLong Thoracic and Phrenic Nerve Invasion by Lung Cancer
Imaging findings
Serial CT chest scans in a patient with infiltrating lung adenocarcinoma show progressive tumor growth invading the apex and mediastinum. There is new, severe atrophy of the right serratus anterior muscle (denervation atrophy) and elevation of the right hemidiaphragm.
Key takeaways
Apical lung cancers (Pancoast tumors) or infiltrative mediastinal tumors can invade adjacent nerves. Invasion of the long thoracic nerve leads to denervation and rapid atrophy of the serratus anterior muscle. Concurrent invasion of the phrenic nerve causes diaphragmatic paralysis and elevation, indicating advanced, locally invasive disease.
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