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Woman With Sarcoidosis, Lymphoma, and Shoulder Pain

Woman With Sarcoidosis, Lymphoma, and Shoulder Pain

 A 56-year-old African American female presented to the outpatient clinic with a six-month history of left shoulder pain. In 2005, she had been diagnosed with sarcoidosis of the lungs and liver, based on on transbronchial and liver biopsies showing epithelioid non-necrotizing granulomas, as well as with cutaneous T-cell lymphoma diagnosed by skin biopsy from the scalp.

Shoulder XrayShe described her shoulder pain as 5/10 in intensity, aching to sharp, mainly on the anterior and lateral aspect of the shoulder but radiating to the arm. The pain was intermittent, relieved by rest and aggravated by movement. Range of motion was decreased compared to the contralateral side, and she was unable to actively abduct her left arm above 90 degrees secondary to pain, which also reduced the extremes of motion by about 20 degrees on all planes.

She denied any history of trauma, neck or back pain, numbness, tingling, or paresthesias in the distal extremity. For the past 2 years, she had been taking prednisone 5 mg daily along with pain medication.

On physical examination, she appeared in mild distress due to joint pain. Her vital signs were unremarkable except for mild hypertension (149/88) and BMI of 34. The erythrocyte sedimentation rate was 50 mm/hr. Other laboratory findings (angiotensin-converting enzyme, antinuclear antibody, and hepatitis A, B, and C antibodies) were all negative.

Laboratory findings showed an erythrocyte sedimentation rate (ESR) of 50 mm/hr. Levels of angiotensin-converting enzyme, antinuclear antibody and Hepatitis A, B and C antibodies were all within the normal range.

Which imaging tests would you order to diagnose this shoulder pain?

For the answer, go to the next page.

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