Question

A 50-year-old man presents with a 2-week history of not being able to see well. He is a married newspaper editor and is not on any medications. He has been smoking 2 packs of cigarettes a day for the past 30 years. On examination of his right eye, there is ptosis and miosis. A chest radiograph reveals a rounded opacity in the right lung field

What is the most likely diagnosis?

1. Lambert-Eaton myasthenic syndrome
2. Hypertrophic pulmonary osteoarthropathy
3. Horner's syndrome
4. Ectopic adrenocorticotropic hormone (ACTH) secretion
5. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer 1

The 50-year-old man's symptoms of ptosis, miosis, and a chest radiograph revealing a rounded opacity in the right lung field are indicative of Horner's syndrome, likely secondary to a compressive lung tumor.

Step-by-step explanation:

The most likely diagnosis for the patient described is Horner's syndrome. This condition typically presents with ptosis (drooping eyelid), miosis (pupillary constriction), and anhidrosis (decreased sweating) on one side of the face.

The presence of a rounded opacity in the right lung field suggests a lung tumor, possibly a Pancoast tumor, which can compress sympathetic nerves and lead to Horner's syndrome.

Other options such as Lambert-Eaton myasthenic syndrome, hypertrophic pulmonary osteoarthropathy, ectopic ACTH secretion, or SIADH are less likely based on the clinical presentation and the findings on the chest radiograph.