PANCOAST AND TOBIAS SYNDROME WITH A HYDAT ID ETIOLOGY

The authors report a case of right-sided complete Pancoast and Tobias syndrome related to a multivesicular extrapleural hydatid cyst develop ing at the cervico-thoracic area with involvement of the first rib. Th is occurred in a 27 year old country dweller who was a non-smoker who presented with a progressive history of right sided cervico brachial n euralgia some four months before hospitalisation, there was a subclavi cular tumour swelling (8-10 cm), solid, non-inflammatory and a right s ided Claude-Bernard-Horner syndrome. Screening of the thorax showed an opacity at the right apex, dense and homogeneous, with a pseudo-fract ure of the first right rib. A cervical echo showed a multiloculated li quid filled mass without connection to the thyroid. Computer tomograph ic scanning showed a multiloculated voluminous liquid filled mass in t he right cervicothoracic area with a regular polycyclic outline, the l ungs were normal. The serology was positive for hydatid disease (haema gglutination and ELISA). The patient was operated on by an exclusively supraclavicular approach with excision of the hydatid membranes and v esicles as well as the right first rib. The immediate outcome resulted in the disappearance of the neuralgia and tire persistence of the Cla ude-Bernard-Horner syndrome.