{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:12Z","timestamp":1784557032938,"version":"3.55.0"},"reference-count":13,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,7]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Distinguishing recurrence of thoracic malignancies from chronic post-thoracotomy pain is challenging, particularly when CT is non-diagnostic. Autonomic symptoms and posture-dependent thoracic pain may provide important diagnostic clues. A male in his 50s with a history of left upper lobectomy for stage IA lung adenocarcinoma presented 3 years postsurgery with new-onset posture-dependent thoracic pain and unilateral anhidrosis on a background of persistent mild postoperative chest pain. Although CT showed no definitive findings suggestive of recurrence, the emergence of autonomic symptoms and intractable pain prompted positron emission tomography\/CT (PET\/CT), which revealed intense uptake in the left T1\u2013T2 paravertebral region, leading to a diagnosis of local recurrence involving the sympathetic chain. Following concurrent chemoradiotherapy, pain improved and the patient returned to work. Posture-dependent thoracic pain with autonomic symptoms may indicate local recurrence even when CT is non-diagnostic, and PET\/CT may facilitate diagnosis in such cases.<\/jats:p>","DOI":"10.1136\/bcr-2026-274787","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:50:19Z","timestamp":1784555419000},"page":"e274787","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Posture-dependent pain and unilateral anhidrosis leading to diagnosis of recurrent lung cancer by positron emission tomography despite non-diagnostic CT"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5042-5045","authenticated-orcid":false,"given":"Megumi","family":"Kanao-Kanda","sequence":"first","affiliation":[{"name":"School of Medicine, Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyuki","family":"Kuriyama","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Kawamata","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"2026072006501059000_19.7.e274787.1","first-page":"363","article-title":"Cancer treatment and survivorship statistics, 2019","volume":"69","author":"Miller","year":"2019","journal-title":"CA A Cancer J Clinicians"},{"key":"2026072006501059000_19.7.e274787.2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx222"},{"key":"2026072006501059000_19.7.e274787.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.02.005"},{"key":"2026072006501059000_19.7.e274787.4","doi-asserted-by":"crossref","unstructured":"Manenti G , Raguso M , D\u2019Onofrio S , et al . 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