Case 32 Answer

Great job folks. I thought this was a tough one as it is more of an eye test thank diagnostic test. Check out the frontal C-spine X-ray as well as the more impressive MR.

Answer: Pancoast tumor.

Reference: http://www.learningradiology.com/archives2008/COW%20294-Pancoast%20Tumor/pancoastccorrect.html