0:00

Here is a patient who presented with vague shoulder pain.

0:03

We can see that there's no evidence of dislocation

0:06

or any severe arthritis.

0:08

However, we must also include in our checklist

0:11

to look in the areas of the lungs.

0:13

If we look carefully here,

0:15

we see a soft tissue opacity projected over the lung apex.

0:19

And here on our subsequent chest x-ray, we see

0:22

that there is a right apex lesion.

0:25

Another example showing not only soft tissue density,

0:29

but also destruction of the ribs from a chest wall lesion.

0:34

And in this case, the subsequent chest X-ray

0:35

shows a pleural based mass.

0:37

So both of those cases are examples of where it's important

0:42

to not only look at the shoulder,

0:43

but also outside the area

0:45

of suspected pathology within the lung.

0:48

Both of those cases ended up being neoplasm

0:50

and being causes of referred shoulder pain.

0:53

So our final shoulder checklist includes Glen Emeral joint.

0:57

We talked about dislocations, anterior posterior signs

1:01

of prior dislocation

1:02

or instability abnormalities at both ends of the clavicle,

1:05

the acromial clavicular joint

1:07

and sternal clavicular, joint scapular lesions,

1:10

scapular fractures, which can be hard to detect

1:13

apical lesions or superior sulcus type tumor

1:15

as we just saw in the last two cases.

1:18

And shoulder pain is very common.

1:21

So oftentimes the radiographs are negative even though

1:23

there's some other internal derangement

1:24

that might be revealed by MRI.

Lung Apex Lesion Summary

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