Man 41 yo, cough and pain at left arm; chest x-rays suspected lung tuberculosis, then he had been treated as antituberculosis for 3 months. But the pain was getting worse and one mass appeared at left supraclavicular fossa. X-rays again showed this first rib in erosion on the left site. Ultrasound scanning at left supraclavicular fossa and disclosed a solid mass in calcification and fluid collection on the right site. MSCT with CE of the lungs detected the mass destructing the first rib. Biopsy was done and microscopy report is adenocarcinoma; a case of PANCOAST TOBIAS SYNDROME.