Disclosures: Pin-Wen Chen, MD: No financial relationships or conflicts of interest

Case Diagnosis: 34-year-old Caucasian male referred for management of back pain, found to have spinal tumor consistent with Schwannoma.

Case Description: Patient reported six months of progressive aching mid-back pain with no inciting event. Two months ago, he presented to the emergency room after developing severe right upper quadrant abdominal and back pain. CT of the abdomen and pelvis was unremarkable. He was referred to outpatient gastroenterology and nephrology for further workup. He underwent HIDA scan, endoscopy, and colonoscopy, all of which were unrevealing. Repeat CT showed a 3 mm left upper pole non-obstructing renal calculus. Upon further questioning, the patient reported decreased sensation in his right leg with unclear onset. Physical exam was notable for decreased strength in his right lower extremity, decreased sensation in the right lower extremity, right abdomen, and right mid and lower back, asymmetric hyperreflexia of the right lower extremity, and inability to tandem walk. Urgent MRI of the thoracic and lumbar spine showed a 2.1 cm intradural, extramedullary, right lateral T7-T8 spinal canal mass contributing to severe spinal canal stenosis and cord compression with cord edema or myelomalacia. He subsequently underwent T7-T8 laminectomy with tumor resection. Pathology was consistent with Schwannoma, WHO grade I.

Setting: Outpatient clinic.Assessment/

Results: Patient followed up in our clinic 2 weeks post-operatively with significant improvement in back pain and sensation, and complete resolution of abdominal pain. Marfan syndrome and Schwannomatosis were ruled out with subsequent workup.

Discussion: Spinal imaging was likely not pursued initially for this patient due to his presentation of right upper quadrant abdominal pain with thoracic back pain, leading to renal and gastrointestinal workup. An in-depth history and neurologic examination pointed to spine pathology.

Conclusion: The atypical presentation of acute abdominal pain in setting of progressive back pain with neurological deficits should raise concern for spinal tumors, especially those with insidious onset.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-right-upper-quadrant-abdominal-pain-in-the-setting-of-progressive-back-pain-an-atypical-presentation-of-intradural-extramedullary-schwannoma-a-case-report/