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11 September 2020 : Case report  Saudi Arabia

Pancoast Tumor: The Overlooked Etiology of Shoulder Pain in Smokers

Mistake in diagnosis

Malak Al Shammari1F*, Ali Hassan2AE, Mahdi Al Jawad2E, Abdulaziz Farea1F, Abdulelah Almansour1B, Ghada Al Yousif1F, Abdulaziz Sebiany1F, Zahia Bin Bakr3B

DOI: 10.12659/AJCR.926643

Am J Case Rep 2020; 21:e926643

Abstract

BACKGROUND: Shoulder pain is a common complaint in general practice and typically has an orthopedic or rheumatological etiology. However, it may be the presenting symptom of a serious underlying condition, such as lung cancer.

CASE REPORT: A 60-year-old man with a 30 pack-year history of smoking presented with worsening right shoulder pain over the last 6 months. He had no respiratory symptoms or weight change. He was seen at several general practice clinics and treated for a rotator cuff injury. However, his pain became severe, to the point that it affected his activities of daily living. A shoulder X-ray revealed opacity in the right apical zone. After a thorough investigation, the patient was found to have lung cancer with local invasion and intracranial metastases. However, in light of the advanced stage of the disease, a palliative approach was taken. The patient remained on multiple oral analgesics for the control of his pain.

CONCLUSIONS: The present case shows that common symptoms such as shoulder pain can be indicative of serious underlying pathology. Physicians should remain alert and maintain a high index of suspicion for Pancoast tumor in patients who are heavy smokers. Furthermore, a chest X-ray needs to be performed in elderly patients and smokers with shoulder pain.

Keywords: Lung Neoplasms, Pancoast Syndrome, shoulder pain

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923