Case 43

A stage IVa NSCLC case with Horner’s Syndrome and its management


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Prof. Dr. med. Alfredo Addeo

Prof. Dr. med.
Alfredo Addeo

Hôpitaux Universitaires de Genève
Médecine Oncologie
Rue Gabrielle-Perret-Gentil 4
1205 Genève


In April 2021, a 64 year old accountant presents himself to our emergency room due to pain in his left arm. He also noticed that his eyes have recently started looking different. This alarmed him so much that he decided to come in right away. Upon closer inspection, he has a left-sided miosis, ptosis and enophthalmus, i. e. a Horner syndrome (figure 1). Furthermore, a supraclavicular swelling on the left is palpable. He does not complain of nausea or headache.

The accountant has no pre-existing conditions nor does he take any regular medication. He also has no prior history of surgical interventions. He is an active smoker with about 30 cigarettes per day, and he is overall in a good general condition. Lately, he lost about 4 kg of weight unintentionally, but he does not report any fever or drenching night sweats.


176 cm, 74 kg, blood pressure 125/80, pulse 72, no fever.

Apart from the Horner’s syndrome, the neurological status of the patient is inconspicuous. The routine blood work shows slightly elevated CRP and ESR without leucocytosis, otherwise the results are normal. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is 0.

Figure 1: Horner’s syndrome on the left

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