Persistent shoulder pain following a motor vehicle accident

A 29-year-old woman had intermittent left shoulder pain during a 4-month period following a motor vehicle accident. Sudden development of a pleuritic component was noted. An elevated left hemidiaphragm of the chest radiograph prompted an ultrasound examination of the abdomen, which revealed a 15-cm complex mass in the left upper quadrant. At surgery, a tumor mass attached to the splenic artery, stomach, and diaphragm was removed. Pathologic studies revealed an encapsulated adrenal hematoma. This case represents an unusual cause of persistent shoulder pain due to diaphragmatic irritation by an adrenal hematoma.