Extract
The incidence of symptomatic thoracic disc herniation has been reported to
be one per million per
year1. Most patients
present with either pain in the chest wall, usually in the distribution of a
thoracic nerve root dermatome, or thoracic myelopathy involving the lower
extremities. However, on rare occasions, other symptoms that might be
suggestive of a shoulder, cardiothoracic, abdominal, or pelvic abnormality may
be the presenting
complaints1-5.
Such symptoms may spur an extensive workup for other disease processes before
a patient is referred to a spine specialist, often as much as a year after the
onset of symptoms. The serious consequences of a late or missed diagnosis
necessitate that a symptomatic thoracic disc herniation, particularly one
accompanied by neurological compromise, be addressed as soon as possible;
therefore, recognition of atypical presentations is important. We report the
case of a forty-one-year-old woman with an eight-month history of nausea and
abdominal pain. Magnetic resonance imaging of the thoracic spine showed a
large central disc herniation at the T9-T10 level. To our knowledge, this is
the first report of a patient with a thoracic disc herniation who presented
with chronic nausea and abdominal pain. The patient was informed that
information concerning this case would be submitted for publication.