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| A Fourteen-Year-Old Boy with Shoulder Pain and Respiratory Symptoms | ||
| By Purushottam A. Gholve, MD, Alexandre Arkader, MD, Harish S. Hosalkar, MD, and David A. Spiegel, MD*, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania | ||
 Fig. 1 Anteroposterior radiograph of the upper chest. For larger view, click on image |
A fourteen-year-old boy was seen at a local emergency department after sustaining an injury to the right shoulder while playing. He was lying on the floor with the left side of his body facing upward when a companion fell on top of him. He felt immediate pain in the right shoulder and anterior aspect of the chest wall, accompanied by transient numbness and weakness of the entire right upper extremity. On physical examination in the emergency room, the area over the anterior aspect of the chest wall was tender to palpation, and the neurovascular examination revealed normal findings. A chest radiograph was made and was interpreted as showing no obvious abnormality (Fig. 1). | |
| The patient was given an analgesic and was discharged home with the right arm in a sling. At home, he experienced some dyspnea but no obvious respiratory distress. The symptoms gradually abated over the course of the next two days but did not completely resolve. The patient presented for an orthopaedic evaluation on the fourth day following the injury. Physical examination at this point showed substantial soft-tissue swelling and discomfort on palpation in the region of the right sternoclavicular joint. He was admitted to the hospital on the basis of the most current symptoms, at which time computed tomographic scans were acquired (Figs. 2 and 3). | ||
 Fig. 2 |
 Fig. 3 |
For larger view, click on image |
| Fig. 2 Axial computed tomographic image at the upper chest level. Fig. 3 3-D computed tomographic reconstruction of the area in Fig. 2. |
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| What is the diagnosis? | ||
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