A patient with left chest trauma develops left shoulder and upper abdominal pain that worsens with inhalation and is associated with mild light-headedness; which condition is most likely?

A patient with left chest trauma develops left shoulder and upper abdominal pain that worsens with inhalation and is associated with mild light-headedness; which condition is most likely?

• A. Ruptured spleen
• B. Shoulder fracture
• C. Acute cholecystitis
• D. Pulmonary embolism

Answer: (A)

Pain in the left shoulder after blunt left-sided chest trauma, with concurrent upper abdominal pain that worsens with inhalation and mild light-headedness, points to diaphragmatic irritation from intra-abdominal bleeding, most likely a splenic rupture. When blood leaks into the peritoneal cavity, the diaphragm is irritated and the phrenic nerve (C3–C5) refers pain to the left shoulder (Kehr sign). The worsening with inhalation reflects the diaphragmatic movement causing more irritation, and light-headedness suggests hypovolemia from internal bleeding. Shoulder fracture would not explain the abdominal pain and lightheadedness after chest trauma. Acute cholecystitis usually presents with right upper quadrant pain and systemic symptoms, not trauma-related left shoulder pain. Pulmonary embolism can cause pleuritic chest pain and dyspnea but is not typically linked to blunt left chest trauma with referred shoulder and abdominal pain.

Pain in the left shoulder after blunt left-sided chest trauma, with concurrent upper abdominal pain that worsens with inhalation and mild light-headedness, points to diaphragmatic irritation from intra-abdominal bleeding, most likely a splenic rupture. When blood leaks into the peritoneal cavity, the diaphragm is irritated and the phrenic nerve (C3–C5) refers pain to the left shoulder (Kehr sign). The worsening with inhalation reflects the diaphragmatic movement causing more irritation, and light-headedness suggests hypovolemia from internal bleeding.

Shoulder fracture would not explain the abdominal pain and lightheadedness after chest trauma. Acute cholecystitis usually presents with right upper quadrant pain and systemic symptoms, not trauma-related left shoulder pain. Pulmonary embolism can cause pleuritic chest pain and dyspnea but is not typically linked to blunt left chest trauma with referred shoulder and abdominal pain.