Disclosures: Yingrong Zhu, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with 4 months of pain in the left thoracic region, extending from the anterior to posterior chest. She denied inciting trauma or events. Her pain was described as sharp, stabbing, pins and needles. She experienced paroxysmal attacks, lasting for a few hours before subsiding. On exam, the patient had full, pain free range of motion of the thoracic spine without tenderness to palpation. Sensation and skin were intact. The patient was diagnosed with pleuritic and myofascial pain and was prescribed etodolac, which alleviated her symptoms.

Setting: Outpatient physiatry office

Patient: 81-year-old woman with thoracic aortic aneurysm Assessment/

Results: On follow-up, the patient returned with decreased sensation of the middle and lower thoracic dermatomes. Thoracic MRI revealed a thoracic aneurysm measuring 4.5 cm, which was compressing the thoracic nerve roots. The patient was diagnosed with thoracic radiculopathy secondary to thoracic aneurysm and advised to see a vascular surgeon.

Discussion: Thoracic radiculopathy is an uncommon spinal pathology that is frequently overlooked in the evaluation of thoracic pain syndromes. The most frequent etiologies of thoracic radiculopathy include thoracic disc disease and diabetes mellitus. While thoracic spinal stenosis and foraminal narrowing are uncommon, the vertebral canal of the thoracic spine is smaller and more rounded compared to the cervical or lumbar spine, putting the thoracic spine at an increased risk of injury from a space-occupying lesion. Diagnosis is difficult as there are no specific physical exam maneuvers. Thus, detailed neurological examination and work up, including EMG and MRI, are key to diagnosis.

Conclusion: Thoracic radiculopathy is an often missed diagnosis in thoracic pain. However, MRI imaging can assist in its diagnoses.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/thoracic-radiculopathy-due-to-thoracic-aneurysm-a-case-report/