[Clinical judgment and decision making in medical practice. A patient with shoulder symptoms]

A 49-year-old man consulted his general practitioner because of left shoulder pain. Analgesics brought no relief. He had a numb feeling in the left axilla. Cervical MRI revealed a herniated disc Cv-Cvi, for which the patient was treated surgically. However, the pain persisted. In retrospect, the axillary numbness could not have been caused by a Cv-Cvi problem, because C6 does not innervate the axilla. Repeated MRI, now of the cervicothoracic region, revealed a tumourous process around TI-TII. Thoracotomy was performed and a mesothelioma was found. The patient died shortly afterwards. It is stressed that the diagnostic satisfaction of a positive MRI finding should not lead to disregarding discrepancies between these radiological results and the clinical findings.