Lessons in clinical reasoning – pitfalls, myths, and pearls: shoulder pain as the first and only manifestation of lung cancer

Julia Díaz-Abad; Amalia Aranaz-Murillo; Esteban Mayayo-Sinues; Nila Canchumanya-Huatuco; Verity Schaye

doi:10.1515/dx-2023-0063

Article

Lessons in clinical reasoning – pitfalls, myths, and pearls: shoulder pain as the first and only manifestation of lung cancer

Julia Díaz-Abad , Amalia Aranaz-Murillo , Esteban Mayayo-Sinues , Nila Canchumanya-Huatuco and Verity Schaye

Published/Copyright: February 23, 2024

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From the journal Diagnosis Volume 11 Issue 2

Abstract

Objectives

Lung cancer is the leading cause of cancer-related death and poses significant challenges in diagnosis and management. Although muscle metastases are exceedingly rare and typically not the initial clinical manifestation of neoplastic processes, their recognition is crucial for optimal patient care.

Case presentation

We present a case report in which we identify the unique scenario of a 60-year-old man with shoulder pain and a deltoid muscle mass, initially suggestive of an undifferentiated pleomorphic sarcoma. However, further investigations, including radiological findings and muscle biopsy, revealed an unexpected primary lung adenocarcinoma. We performed a systematic literature search to identify the incidence of SMM and reflect on how to improve and build on better diagnosis for entities as atypical as this. This atypical presentation highlights the importance of recognizing and addressing cognitive biases in clinical decision-making, as acknowledging the possibility of uncommon presentations is vital. By embracing a comprehensive approach that combines imaging studies with histopathological confirmation, healthcare providers can ensure accurate prognoses and appropriate management strategies, ultimately improving patient outcomes.

Conclusions

This case serves as a reminder of the need to remain vigilant, open-minded, and aware of cognitive biases when confronted with uncommon clinical presentations, emphasizing the significance of early recognition and prompt evaluation in achieving optimal patient care.

Keywords: pain; musculoskeletal metastasis; lung cancer; cognitive bias; adenocarcinoma; a case report

Corresponding author: Julia Díaz-Abad, Department of Internal Medicine, Clínico San Cecilio University Hospital, Av. del Conocimiento, s/n, 18016, Granada, Spain, E-mail: jdiazahums@gmail.com

Research ethics: Not applicable.
Informed consent: Informed consent was obtained from the patient and all the data included in the work has been duly anonymized.
Author contributions: All authors contributed to the study’s conception and design. Julia Díaz, Amalia Aranaz, and Nila Canchumaya performed material preparation and data collection. Julia Díaz wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Received: 2023-06-02

Accepted: 2024-01-16

Published Online: 2024-02-23

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Articles in the same Issue

https://doi.org/10.1515/dx-2023-0063

Keywords for this article

pain; musculoskeletal metastasis; lung cancer; cognitive bias; adenocarcinoma; a case report