Ann Rehabil Med.  2016 Jun;40(3):534-539. 10.5535/arm.2016.40.3.534.

Thoracic Radiculopathy due to Rare Causes

• Choi HE
• Shin MH
• Jo GY
• Kim JY

• KMID: 2327617
• DOI: http://doi.org/10.5535/arm.2016.40.3.534

Abstract

Thoracic radiculopathy represents an uncommon spinal disorder that is frequently overlooked in the evaluation of thoracic, or abdominal pain syndrome. The clinical representation of this uncommon disorder is often atypical. With many differential diagnoses to consider, it is not surprising that the cause of thoracic radiculopathy is often not discovered for months, or years, after the symptoms arise. We report two rare cases of thoracic radiculopathy; one case was caused by extraskeletal Ewing sarcoma (EES) along the thoracic paraspinal area, and the other by foraminal stenosis, due to a bony spur of the thoracic vertebra. As such, thoracic radiculopathy should be considered in the diagnosis of patients with thoracic and abdominal pain, especially if initial diagnostic studies are inconclusive.

Keyword

Radiculoapthy; Abdominal pain; Ewing sarcoma

MeSH Terms

Abdominal Pain
Constriction, Pathologic
Diagnosis
Diagnosis, Differential
Humans
Radiculopathy*
Sarcoma, Ewing
Spine

Figure

• 

  Fig. 1 Black lines delineate the area where the patients of case 1 (A) and case 2 (B) indicated their right upper quadrant pain location on the abdomen.

• 

  Fig. 2 The results of needle electromyography in case 1 (A) and case 2 (B) which show the abnormal spontaneous activities were detected in right parathoracic muscles of the T8-9 level.

• 

  Fig. 3 Contrast enhanced magnetic resonance image of the T spines. Sagittal T2 (A), sagittal T1 (B), and axial T1 (C) weighted imaging demonstrate well-enhanced lobulated mass (arrow) along right paraspinal area, extending to the right neural foramen of T8-9.

• 

  Fig. 4 Photomicrograph: low power (A) and high power (B) views of a Ewing sarcoma. The excised specimen consisted of a ganglion partially replaced by tumor cells (A, ×20). The neoplastic cells were small, round, and uniform, with scant cytoplasm (B, ×400).

• 

  Fig. 5 Sagittal (A) and axial (B) planes of non-enhanced three-dimensional computed tomography of thoracic spine show stenosis of right T8-9 intervertebral foramen with bony spur encroachment (arrow).

Reference

1. O'Connor RC, Andary MT, Russo RB, DeLano M. Thoracic radiculopathy. Phys Med Rehabil Clin N Am. 2002; 13:623–644. PMID: 12380552.

2. Mammis A, Bonsignore C, Mogilner AY. Thoracic radiculopathy following spinal cord stimulator placement: case series. Neuromodulation. 2013; 16:443–447. PMID: 23682904.

3. Mukhopadhyay P, Gairola M, Sharma M, Thulkar S, Julka P, Rath G. Primary spinal epidural extraosseous Ewing's sarcoma: report of five cases and literature review. Australas Radiol. 2001; 45:372–379. PMID: 11531770.

4. Yasuda T, Suzuki K, Kanamori M, Hori T, Huang D, Bridge JA, et al. Extraskeletal Ewing's sarcoma of the thoracic epidural space: case report and review of the literature. Oncol Rep. 2011; 26:711–715. PMID: 21617880.

5. Su JL, Tan WC, Chao CC, Tsai CM, Wu CH. An initial presentation of flank pain caused by thoracic disc herniation. J Emerg Crit Care Med. 2010; 21:221–226.

6. Ozturk C, Tezer M, Sirvanci M, Sarier M, Aydogan M, Hamzaoglu A. Far lateral thoracic disc herniation presenting with flank pain. Spine J. 2006; 6:201–203. PMID: 16517394.

7. Iwamoto Y. Diagnosis and treatment of Ewing's sarcoma. Jpn J Clin Oncol. 2007; 37:79–89. PMID: 17272319.

8. Guyot-Drouot MH, Cotten A, Flipo RM, Lecomte Houcke M, Delcambre B. Contribution of magnetic resonance imaging to the diagnosis of extraskeletal Ewing's sarcoma. Rev Rhum Engl Ed. 1999; 66:516–519. PMID: 10567983.

9. Rustagi T, Badve S, Parekh AN. Sciatica from a foraminal lumbar root schwannoma: case report and review of literature. Case Rep Orthop. 2012; 2012:142143. PMID: 23259107.

10. Dumitru D, Zwarts MJ. Lumbosacral plexopathies and proximal mononeuropathies. In : Dumitru D, Amato AA, Zwarts MJ, editors. Electrodiagnostic medicine. 2nd ed. Philadelphia: Hanley & Belfus;2002. p. 750–751.