• Dong Gyu Lee and Min Cheol Chang.
• Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea.
• Medicine (Baltimore). 2017 Oct 1; 96 (42): e8288.

RationaleInformation on referred pain can be helpful for diagnosing diseases of the visceral organs. Here, the authors report a patient with cervical spinal cord injury (SCI) who had referred pain at the right side from the neck to shoulder, as a presentation of pulmonary embolism (PE).Patient ConcernsA 55-year-old man with complete tetraplegia, due to cervical SCI after C5 and C6 vertebral body fracture, complained of right neck-to-shoulder pain (numerical scale rating: 6). Despite pain medication (meloxicam 15 mg, gabapentin 400 mg, and propacetamol HCl 1 g), the pain was not reduced. Along with right neck-to-shoulder pain, he presented mild fever (37.8°C) and mildly elevated respiratory rate (20 breaths/min). D-dimer level was also mildly elevated to 6.09 mg/mL (normal value: < 0.5 mg/mL).DiagnosesComputed tomography pulmonary angiography revealed PE in the right lower lobe pulmonary artery.InterventionsFor managing PE, rivaroxaban was administered for three days.OutcomesAfter the administration of rivaroxaban, the patient's pain completely disappeared.LessonsThis study shows that pain at the neck-to-shoulder area can occur following unexpected causes such as PE. Not limited to PE, the evaluation of diseases in the thoracic or abdominal organs is recommended if patients with cervical SCI present refractory pain in the dermatomes innervated by high cervical nerve roots.

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