Hemorrhagic Abdominal Mass Presenting as Shoulder Pain in the Emergency Department

Jeanine Awad Spirtos

Department of Emergency, Cleveland Clinic Akron General, USA

^*Correspondance to: Jeanine Awad Spirtos 

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Abstract:

Shoulder pain is a common complaint in the Emergency Department (ED) and it is often secondary to musculoskeletal causes. Patients who have multiple presentations to the ED with a similar chief complaint and no indications of musculoskeletal etiology should be evaluated for differential diagnosis based on the potential for referred pain. We present a case of a patient who had several ED and outpatient visits over the course of 18 months for shoulder pain. Initial imaging studies were unremarkable and the patient was discharged with instructions for conservative pain management. The patient developed abdominal pain several months after the onset of shoulder pain, prompting further investigation. Abdominal and pelvic CT scans revealed a large intra-abdominal tumor herniating the patient’s diaphragm. The shoulder pain was determined to be secondary to diaphragmatic irritation. The patient underwent emergent surgery to remove the mass from the adjacent structures. The final pathology for tumor was positive for synovial sarcoma.

Keywords:

Referred pain; Synovial cell carcinoma; Shoulder Pain

Cite the Article:

Spirtos JA. Hemorrhagic Abdominal Mass Presenting as Shoulder Pain in the Emergency Department. Ann Clin Case Rep. 2018; 3: 1505.