Author: Jacob Bright, DO Candidate
Co Author #1: Mark Rogers DO
Co Author #2: James Farmer MD
Co Author #3: Megan Sauviac

Patient Presentation:
A 21-year-old collegiate male cheerleader presented to their athletic trainer with a two-week history of progressively enlarging right supraclavicular mass in late August 2011. The mass was associated with a dull, constant ache that was exacerbated by lifting weights and athletic performance. The mass was insidious in onset with no recent history of trauma.
The patient denied fever, chills, and night sweats. There was no history of weight loss, nausea, or vomiting.

History:
Significant Past Medical and Surgical History: December 2010 – fracture of the proximal third of the right clavicle that was corrected with open reduction internal fixation utilizing plate and three screws after nonunion.
Medications: None
Family History: Negative for cancer or masses of any type.
Social History: Denied exposure to animals, birds, or tuberculosis. No illicit drug use.

Physical Exam:
Vital signs were stable (5’10 and 158 pounds, Pulse 77 bpm, Blood pressure in right arm 124/85 mmHg). Athlete appeared awake, alert, and oriented, and in no acute distress.
Neurologic exam and cranial nerve exam were both normal. Oropharynx was clear upon visualization. Cardiovascular exam revealed normal S1, S2 with normal rate and rhythm; no murmurs were present. Peripheral pulses were present and adequate. Lungs were clear to auscultation bilaterally. Abdomen was soft and nontender. No organomegaly was detected and normal bowel sounds were heard in all four quadrants.
Neck was supple but there was a non-pulsatile, fist-sized mass located superior to the medial end of the right clavicle. Case Photo #1 , Case Photo #2 , Case Photo #3 , Case Photo #4 There was no overlying erythema or warmth and the mass was nontender to palpation. Range of motion was normal in all planes for neck and bilateral shoulders. No regional (axillary or cervical) lymphadenopathy was detected. Muscle strength was rated 5/5 bilaterally. Patient reported a feeling of fullness and mild pain upon flexing his arm beyond 90 degrees.

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