Radiographic Findings and Differential Diagnosis
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Plain films of the left shoulder dated 8-28-00 revealed marked
superior subluxation of the humerus with only 2 mm of
space between the acromion and the superior humeral head.
There is associated cystic formation at the rotator
cuff insertion site. These findings are consistent with moderate
rotator cuff arthropathy which suggest a complete rotator
cuff tear. Mild non uniform joint space narrowing and inferior
osteophyte formation is present at the acromioclavicular joint
consistent with moderate acromioclavicular joint arthropathy.
There are quite specific radiographic findings which certainly
could explain the patient's long term shoulder pain and are
consistent with a history of rotator cuff tear three years
ago. However, a complete radiographic search pattern should
always include a careful examination of the soft tissues,
the undiscovered country. In the left upper lobe of the lung,
seen best on the incompletely abducted baby arm view, there
is a large, ill-defined mass lesion measuring over
4 cm overlying the left 3rd and 4th ribs. Comparison was made
to previous radiographs obtained on 3-14-97. No abnormality
was visualized in the lung fields at this time.
The patient was referred to an oncologist and a CT scan was
ordered on 9-29-00.
The oncologist commented that the patient was feeling "perfectly
well". There were no specific clinical complaints related
to possible malignancy.
COMPUTED TOMOGRAPHY (CT) SCAN FINDINGS:
· Irregular, lobulated soft tissue mass in the superior
aspect of the left upper lobe laterally.
· A tiny 8 mm module at the anterior aspect of the right
upper lobe was also noted, etiology indeterminate.
· There was mild left hilar adenopathy adjacent to the left
mainstream bronchus and left pulmonary artery which were worrisome
for metastatic disease to the lymph nodes.
· Diffuse dilatation and thickening of the wall of the lower
esophagus was also noted, with recommendation for direct visualization
of this region using endoscopy.
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Introduction to Unknown Cases
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