Intended for healthcare professionals

Endgames Spot Diagnosis

Sharp shoulder pain, getting worse, after a fall

BMJ 2017; 356 doi: (Published 16 February 2017) Cite this as: BMJ 2017;356:j571
  1. Lauren Ramsay, radiology specialist registrar
  1. Royal Surrey County Hospital, Guildford, UK
  1. Correspondence to L Ramsay laurie.ramsay{at}

A 62 year old man saw his general practitioner with worsening shoulder pain after a minor fall. The GP requested a radiograph. On the basis of the radiograph alone (fig 1), what imaging would you request next?

Fig 1

Anteroposterior plain radiograph of the right shoulder

Short answer

Computed tomography (CT) of the chest and upper abdomen. The shoulder radiograph shows a cavitating lung nodule measuring approximately 2 cm (fig 2). This is most likely a primary lung carcinoma and should be investigated with referral to the …

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