The incidence of symptomatic thoracic disc herniation (TDH) has been reported as 1 per million per year. Most patients present with either radiculopathy as pain in the chest wall or thoracic myelopathy involving the lower extremities. However, various other symptoms suggestive of other diseases such as coronary artery disease, aorta dissection, or visceral disease can be the sole presenting complaints. Such confusing symptoms may lead to either unnecessary operations based on misdiagnosis or progressive neurological compromise. To avert such mishaps, an understanding of the atypical presentations of TDH is necessary. We describe herein a rare case of a patient who presented with predominant abdominal pain caused by TDH.
Treatment of herniated thoracic discs includes both operative and nonoperative options. Although symptomatic TDH is uncommon, a missed or delayed diagnosis can be problematic, potentially resulting in not only unnecessary surgical procedures based on misdiagnosis, but also progressive myelopathy and permanent paralysis. Thoracic disc herniation thus needs to be kept in mind as a cause of symptoms mimicking other non-spinal disorders. In addition to thorough neurological examination, MRI and electrophysiological examinations are helpful in achieving earlier diagnosis.
Hiroyasu Fujiwara, Thoracic Disc Herniation Presenting with Predominant Abdominal Pain
Last date updated on June, 2014