One of my primary care patients, a generally healthy man in his mid-50s who was a current smoker, developed left scapular pain followed by numbness in the left shoulder and upper arm. Approximately 1 week after the onset of pain, he became unable to raise his left arm with preservation of distal strength. A colleague saw him urgently and was concerned about a brachial plexus or cervical spine lesion. The patient had no pulmonary symptoms. A chest radiograph showed clear apices but a “left pleural effusion with adjacent atelectasis or pneumonia.”
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