Woman with Malaise, Cough, and Shoulder Pain

ANSWER


The radiograph demonstrates a slightly elevated left hemidiaphragm, which is nonspecific, as well as normal to slightly increased lung markings. There is no definite infiltrate or consolidation noted.

Of note, there is a displaced fracture of the mid-distal left clavicle, which may be partially healed. There appears to be a focal lytic lesion within that area. The surrounding bone is extremely osteopenic as well.

These findings, especially in the absence of injury or trauma, raise the question of a pathologic fracture, and further workup is warranted. Subsequent workup on this patient demonstrated a large renal mass, which was felt to be, most likely, a metastatic lesion.