title: Renal Cell Carcinoma Presenting as Radiating Rib Pain: A 65-Year-Old Woman.
abstract: OBJECTIVE
  The purpose of this case report is to describe chiropractic management and referral of a patient with rib pain who was subsequently diagnosed with renal cell carcinoma.
  
  
  METHODS
  A 65-year-old woman presented with radiating rib pain to a chiropractic clinic. She was treated with a 2-week course of conservative care. On follow-up evaluation, she reported a deep ache over her lower ribs, wrapping around to her abdomen. Palpation under the anterior rib cage reproduced her pain, and she also had a positive Murphy Sign. She was referred for an abdominal ultrasonography.
  
  
  RESULTS
  Ultrasonography showed a 12-cm solid vascular mass of the right kidney. Further imaging studies using computerized tomography and magnetic resonance imaging confirmed the ultrasonography findings. She was referred to a cancer center for staging of the cancer and subsequent surgical treatment. The involved tissue, as well as the kidney and part of the inferior vena cava, was removed, and the pathology report determined that the mass was clear cell carcinoma.
  
  
  CONCLUSIONS
  This case describes an unusual presentation of a patient with rib pain that had previously undiagnosed renal cancer. Referral by her doctor of chiropractic resulted in detection of the tumor and treatment.
authors.affiliation: Assistant Clinical Professor, Palmer College of Chiropractic Clinics, Port Orange, FL.
authors.forename: Gregory
authors.initials: G
authors.lastname: Cofano
authors.affiliation: Assistant Clinical Professor, Palmer College of Chiropractic Clinics, Port Orange, FL.
authors.forename: Meredith
authors.initials: M
authors.lastname: Meyers
authors.affiliation: Assistant Clinical Professor, Palmer College of Chiropractic Clinics, Port Orange, FL.
authors.forename: Adam
authors.initials: A
authors.lastname: Sergent
authors.affiliation: Doctor of Chiropractic, Private Practice of Chiropractic, Baraga, MI.
authors.forename: Shawn
authors.initials: S
authors.lastname: LaCourt
keywords: Carcinoma; Chiropractic; Pain; Renal cell; Ribs