Double Trouble: Gallstones, Vaping, and Shoulder Pain
- drjparente
- Jun 22
- 2 min read
By Dr. John Parente, Emergency Medicine Physician
When a 40-year-old woman came into the ER complaining of right upper quadrant abdominal pain, right-sided chest pain, and right shoulder pain, the initial differential diagnosis was broad, and things got interesting quickly.
Let’s start with the abdominal pain and shoulder discomfort. These two often travel together, especially when the diaphragm is involved. In this case, the patient had cholelithiasis, or gallstones. When gallstones cause inflammation in the gallbladder, it can irritate the diaphragm. This diaphragmatic irritation then refers pain to the right shoulder—a classic example of Kehr’s sign. It’s a fascinating example of how the body’s wiring sometimes sends pain signals to places far from the actual source.
The patient also had sharp, pleuritic right-sided chest pain, which didn't quite fit with a simple gallbladder diagnosis. When we did the CT scan of the abdomen, and also confirmed on plain chest X-Ray, we did see a surprise: a pneumothorax —air in the chest cavity caused by a collapsed lung. The culprit? Vaping. Unfortunately, the pressure changes and irritation to lung tissue associated with vaping can, in some cases, lead to a spontaneous pneumothorax, especially in otherwise healthy individuals.
We placed a chest tube to re-expand the lung and get her on the road to recovery. Fortunately, both her gallbladder issue and the pneumothorax were caught early and managed effectively.
This case was a perfect storm—two very different problems presenting at the same time, with overlapping symptoms. It’s a powerful reminder of how nuanced medicine can be, and how dangerous assumptions (even ones as simple as "vaping is harmless") can lead to real health risks.
Thanks for reading and for playing along with another case from the pit. These real-life stories remind us how critical it is to listen closely to what the body is saying—sometimes, it’s speaking in code.
👨⚕️ Dr. John Parente
Emergency Medicine
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