NWHSU logo
Challenge of the Unknowns—Unknown 7

Radiographic Findings and Differential Diagnosis

Click any of the images on this page to review films and listen to further audio discussion by Dr. Jeff Rich



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.

3-14-97 for comparison

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.


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.



Click here for Diagnosis and Discussion


Introduction to Unknown Cases

Page 1 2 3




Questions? Comments? Send e-mail to Northwestern Health Sciences University Web Coordinator.
2001 Northwestern Health Sciences University/ www.nwhealth.edu - All Rights Reserved
Copyright Information