Pancoast's apical bronchial carcinoma
This 72 year old retired engineer, a former smoker, presented to his GP complaining of a recent onset cough, productive of sputum and containing “spots” of fresh blood. He also said that he had recently been more breathless than normal on walking to collect his morning newspaper.
On examination the left apex was dull to percussion and there were increased breath sounds over this area. There was also a reduction in chest expansion on the left side. His left eyelid was slightly droopy and the pupil seemed smaller on that side.