[Clinical judgment and decision making in medical practice. A patient with shoulder symptoms].
A 49-year-old man consulted his general practitioner because of left shoulder pain. Analgesics brought no relief. He had a numb feeling in the left axilla. Cervical MRI revealed a herniated disc Cv-Cvi, for which the patient was treated surgically. However, the pain persisted. In retrospect, the axillary numbness could not have been caused by a Cv-Cvi problem, because C6 does not innervate the axilla. Repeated MRI, now of the cervicothoracic region, revealed a tumourous process around TI-TII. Thoracotomy was performed and a mesothelioma was found. The patient died shortly afterwards. It is stressed that the diagnostic satisfaction of a positive MRI finding should not lead to disregarding discrepancies between these radiological results and the clinical findings.
Mazel
J A
JA
Roolvink
E G
EG
D018771:Arthralgia / Q000209:etiology*; D002574:Cervical Vertebrae; D017809:Fatal Outcome; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008654:Mesothelioma / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010997:Pleural Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D011859:Radiography; D012785:Shoulder Joint / Q000000981:diagnostic imaging