Question

15 year-old female field hockey player presents with left shoulder pain. Besides fatigue over several weeks, she has no past medical history and there is nothing remarkable on physical exam. What's the diagnosis? 

Answer

Mediastinal mass (lymphoma confirmed on biopsy)

• There was no bony abnormality of the shoulder but the mediastinal mass was nearly missed because the focus was on the shoulder
• Below is Xray after patient started receiving chemotherapy.
• Bottom Line: always be sure to evaluate the entire Xray because sometimes you'll discover unrelated, but important findings 

References

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