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Have GERD and abdominal pain. Taking nexium. Chest x-ray clear. Worried for pancoast's tumour

Mar 2013
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I am 51 year old female. I am taking Nexium and a antispasmodic for severe Gerd. I also take a anti cholestrol medication and I take synthroid medication. I have no high blood presses. I am now taking a iron pill , due to anemia that was recently found on cbc. I had a abdominal ct scan due to horrible pain in the abdomen and they found diviticulitis and was on antibiotis, it seems to be cleared up. I also had a ultra sound for gallbladder, all clear. I had a chest x XXXXXXX due to breathing issues and all was perfectly clear. I used to smoke several years ago, I quit. The doctor thought it was Gerd related. I think I am in perimenopause, missed a period, not pregnant. I have this awful fatigue going on. I went to my doctor for pain in the back of my neck, top of shoulder , between shoulder blades, and on the top of my bicep. She gave me muscle relaxers for the pain. It feels like a pinch in the neck. It's been going on for a week now. It comes and goes in intensity. Right now the pain is more to the side of my right neck and on top of the shoulder. I am aware of referred pain from the esophageal spasams that I have, but this feels different. The chest xray was two weeks ago. My specific question is, could this be lung cancer related and they missed it on the chest xray? I am aware of a Pancost tumor from reading and there is no numbness in hand , or fingers.My throat feels very tight, but I have had that before and know it's a spasam taking place in the esophagus. I have recently seen my gastro doctor. I had a scope last year in Feb. I was not having the shoulder pain then , just pain between shoulder blades. I have had that for 5 years off and on. Should I be worried that this is something else? I asked my doctor about Pancoast and she had never heard of one. She knew chest xray was clear . Thank for very much.
Posted Tue, 26 Mar 2013 in GERD
Answered by Dr. Aarti Abraham 2 hours later
thanks for your query.

Pancoast's tumour is an extremely rare tumour, as you must be aware as you have read it up.Apart from Severe pain in the shoulder region radiating toward the axilla and scapula along the ulnar aspect of the muscles of the hand, there would be accompanying symptoms like :

Atrophy of hand and arm muscles
Horner syndrome (ptosis, miosis, hemianhidrosis, enophthalmos)
Compression of the blood vessels with edema

In addition, the pain is frequently relentless and unremitting, and adequate relief often requires administration of narcotics. The patient usually supports the elbow of the affected arm in the hand of the opposite upper extremity to ease the tension on the shoulder and upper arm.

You are having none of these.
Also in the 5 years that you have been having the pain, you would have definitely shown other symptoms if you had Pancoast.

The differential diagnoses of arm and shoulder pain are extensive; however, the primary conditions that must be excluded are thoracic outlet syndrome and cervical disk disease, which are commonly mistaken for Pancoast syndrome in the early clinical course. Careful neurologic examination, electromyographic studies, and ulnar nerve studies are performed to verify the precise diagnosis.

You are somewhat right in your apprehensions, because Pancoast is notorious for a late diagnosis, as it rarely shows up on a Chest X XXXXXXX
You require CT / MRI for exact imaging.

I guess you should consult a Specialist to rule out other causes of shoulder pain which are more common, and then, just to XXXXXXX your anxiety, you could insist on a CT to dispel your doubts.

Take care.

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