What Causes Right-sided Abdominal Pain Radiating To The Tip Of The Shoulder?

Posted on Fri, 16 Jun 2017

Question: Hello, I have for the last few months had low-grade nausea, usually after eating. About 2 weeks ago I began running a low grade fever (99.5 or so consistantly) and experiencing sharp pain in my right shoulder tip that doesn't appear to be triggered by any physical activity or resolve by not using it. It does get worse with deep breaths. After seeing my doctor I was sent for an abdominal ultrasound and chest ct. Chest ct was negative, ultrasound showed enlarged liver and spleen and could not get a good look at the gallbladder. The only unusual blood test result was an elevated d dimer, which led to the chest ct. I had an abdominal ultrasound a couple years ago for an unrelated issue and my liver and spleen are not just naturally large. My dr wants to repeat the ultrasound in 3 months but I just don't feel well, between the nausea and fever I am just dragging and don't want to wait that long for a resolution. I am looking for answers. The only other possible, though I imagine unrelated, symptom is a soft lump that begins in my neck on the right side and goes up over my jaw which is making my face slightly asymetrical, there is no pain related to the lump. Please note that I am not a drinker, I do not smoke, do drugs or even take a tylenol if it can be avoided. I appreciate any insights you can offer.

Answered by Dr. Sunil (1 hour later)

Brief Answer:
Can be gallbladder pathology.

Detailed Answer:
Hello,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.

As per your narration the radiologist can't get a clear view of gall bladder.
Pain in right side of abdomen radiating to tip of shoulder can be a classical feature of problem with gall bladder.Problem may bary from having stones to inflammation in gall bladder.
As per the other details provided by you CT of chest was done but a CT of abdomen should have been done to get a clear picture of gallbladder and to rule out possibility of cholelythiasis or chronic cholecystitis.

Secondly it could be Kehr's sign.Kehr's sign is a classic example of referred pain irritation of the diaphragm irritates the phrenic nerve causing pain in abdomen referred to shoulders.This is because the supraclavicular nerves have the same cervical nerves origin as the phrenic nerve, C3 and C4.

Nausea and vomiting are most common symptoms among all types of gallbladder problems. Sudden and rapidly intensifying pain in the upper right portion of your abdomen with radiation to shoulder is highly suggestive of problem in gall bladder.Inflammation of the gallbladder can be caused by gallstones, infections, or even tumors that cause bile buildup.

Fever is indicator of ongoing infection.

Suggestion-
Please go for a CT scan abdomen to rule out gallbladder problem.
Its surprising that your primary had repeated CT chest twice but CT abdomen was not done.
USG is just a baseline test of Gastroenterology and many times view is not good.
So go for a CT scan asap.

Thanks.

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Above answer was peer-reviewed by : Dr. Nagamani Ng