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A 45-year-old male is brought to the emergency department after an automobile accident. He is hypotensive and complaining of left shoulder pain. Radiographs of his shoulder are unremarkable. Injury to which of the following organs most likely explains his symptoms?

A. Gall bladder
B. Large intestine
C. Left lung
D. Liver
E. Small intestine
F. Spleen
G. Stomach
 

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Splenic injury & rupture is very common in the trauma setting. This kind of injury may present as ipsilateral shoulder pain (Kehr's sign), due to shared innervation of both the diaphragm (which is irritated by the blood form the spleen) and the area around the shoulder by the phrenic nerve. I.e. this shoulder pain is a type of referred pain.

(I couldn't help commenting, sorry guys!:))
 
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