ANSWER
There is no evidence of an acute fracture or dislocation. However, there is a focal lytic lesion within the scapula. Given a presumed history of renal cell carcinoma, this finding is strongly suspicious for metastasis and must be worked up.
Radiology Review
Shoulder Pain in Man Hospitalized for Brain Mass
A 53-year-old man is admitted with a possible brain mass. He gives a two-week history of headaches and intermittent left-sided weakness. Outpatient CT of the head showed a possible right frontal mass. His medical history is significant for mild hypertension and for the removal of one kidney seven years ago, due to cancer. He states he received no adjuvant therapy. When you check on the patient today, he mentions that his left shoulder has been bothering him for some time. He denies any injury to it. He states he has decreased range of motion and pain with range of motion. You order a radiograph of the shoulder (shown). What is your impression?