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Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report

RATIONALE: Information on referred pain can be helpful for diagnosing diseases of the visceral organs. Here, the authors report a patient with cervical spinal cord injury (SCI) who had referred pain at the right side from the neck to shoulder, as a presentation of pulmonary embolism (PE). PATIENT CO...

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Autores principales: Lee, Dong Gyu, Chang, Min Cheol
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662395/
https://www.ncbi.nlm.nih.gov/pubmed/29049229
http://dx.doi.org/10.1097/MD.0000000000008288
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author Lee, Dong Gyu
Chang, Min Cheol
author_facet Lee, Dong Gyu
Chang, Min Cheol
author_sort Lee, Dong Gyu
collection PubMed
description RATIONALE: Information on referred pain can be helpful for diagnosing diseases of the visceral organs. Here, the authors report a patient with cervical spinal cord injury (SCI) who had referred pain at the right side from the neck to shoulder, as a presentation of pulmonary embolism (PE). PATIENT CONCERNS: A 55-year-old man with complete tetraplegia, due to cervical SCI after C5 and C6 vertebral body fracture, complained of right neck-to-shoulder pain (numerical scale rating: 6). Despite pain medication (meloxicam 15 mg, gabapentin 400 mg, and propacetamol HCl 1 g), the pain was not reduced. Along with right neck-to-shoulder pain, he presented mild fever (37.8°C) and mildly elevated respiratory rate (20 breaths/min). D-dimer level was also mildly elevated to 6.09 mg/mL (normal value: < 0.5 mg/mL). DIAGNOSES: Computed tomography pulmonary angiography revealed PE in the right lower lobe pulmonary artery. INTERVENTIONS: For managing PE, rivaroxaban was administered for three days. OUTCOMES: After the administration of rivaroxaban, the patient's pain completely disappeared. LESSONS: This study shows that pain at the neck-to-shoulder area can occur following unexpected causes such as PE. Not limited to PE, the evaluation of diseases in the thoracic or abdominal organs is recommended if patients with cervical SCI present refractory pain in the dermatomes innervated by high cervical nerve roots.
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spelling pubmed-56623952017-11-21 Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report Lee, Dong Gyu Chang, Min Cheol Medicine (Baltimore) 3300 RATIONALE: Information on referred pain can be helpful for diagnosing diseases of the visceral organs. Here, the authors report a patient with cervical spinal cord injury (SCI) who had referred pain at the right side from the neck to shoulder, as a presentation of pulmonary embolism (PE). PATIENT CONCERNS: A 55-year-old man with complete tetraplegia, due to cervical SCI after C5 and C6 vertebral body fracture, complained of right neck-to-shoulder pain (numerical scale rating: 6). Despite pain medication (meloxicam 15 mg, gabapentin 400 mg, and propacetamol HCl 1 g), the pain was not reduced. Along with right neck-to-shoulder pain, he presented mild fever (37.8°C) and mildly elevated respiratory rate (20 breaths/min). D-dimer level was also mildly elevated to 6.09 mg/mL (normal value: < 0.5 mg/mL). DIAGNOSES: Computed tomography pulmonary angiography revealed PE in the right lower lobe pulmonary artery. INTERVENTIONS: For managing PE, rivaroxaban was administered for three days. OUTCOMES: After the administration of rivaroxaban, the patient's pain completely disappeared. LESSONS: This study shows that pain at the neck-to-shoulder area can occur following unexpected causes such as PE. Not limited to PE, the evaluation of diseases in the thoracic or abdominal organs is recommended if patients with cervical SCI present refractory pain in the dermatomes innervated by high cervical nerve roots. Wolters Kluwer Health 2017-10-20 /pmc/articles/PMC5662395/ /pubmed/29049229 http://dx.doi.org/10.1097/MD.0000000000008288 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 3300
Lee, Dong Gyu
Chang, Min Cheol
Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report
title Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report
title_full Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report
title_fullStr Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report
title_full_unstemmed Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report
title_short Neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: A case report
title_sort neck-to-shoulder pain as an unusual presentation of pulmonary embolism in a patient with cervical spinal cord injury: a case report
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662395/
https://www.ncbi.nlm.nih.gov/pubmed/29049229
http://dx.doi.org/10.1097/MD.0000000000008288
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