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Publication Date
4-30-2025
Keywords
oaa, oregon gme, ppmc gme, ppmc
Disciplines
Internal Medicine | Medical Education | Orthopedics
Abstract
Case Presentation: •Background: Non-traumatic diaphragmatic rupture is a rare condition, only 28 cases previously reported •73 year old female presented to PCP via virtual visit with 6 weeks of gradually worsening shoulder pain despite recent steroid injection. During the virtual visit, patient was found with dyspnea on exertion •PMHx: Recurrent ovarian cancer (granulosa cell type) •Surgical Hx: Hysterectomy with BSO, Lap partial hepatectomy with cauterization of right diaphragm metastasis 7 years prior to presentation •Vitals: normal, on RA •Exam: No R shoulder focal tenderness or limited movement •Labs: CBC - WBC 13.7 with absolute neutrophil count 11.2. CMP - normal. Trop < 0.01. BNP 43 •EKG: normal Discussion: •There are 2 cases of non-traumatic diaphragmatic rupture associated to ovarian cancer •Diagnosis of non-traumatic diaphragmatic rupture is difficult to diagnose with imaging alone as seen in this case, 66% of ruptures are missed on initial imaging •Differential diagnosis for right shoulder pain is broad, including cardiac, pulmonary, shoulder joint, musculoskeletal and autoimmune, neoplasm, bone, diaphragmatic irritation, etc. •In primary care, shoulder pain is common •The main distinguishing factor between intrinsic shoulder pain verses referred pain is that with referred pain, movement is normal. Referred pain does not become aggravated with movement •In cases of referred shoulder pain, diaphragmatic pathology should be considered, and in individuals with a history of cancer, this should include consideration of metastatic disease Teaching Points: •Presentation of non-traumatic diaphragmatic rupture can be due to an ovarian malignancy •Non-traumatic diaphragmatic rupture, especially on the right side, can be difficult to diagnose on imaging alone •In primary care, shoulder pain with normal movement indicates evaluation beyond the shoulder joint
Area of Special Interest
Orthopedics & Sports Medicine
Specialty/Research Institute
Internal Medicine
Specialty/Research Institute
Graduate Medical Education
