Turkish Neurosurgery 2012 , Vol 22 , Num 3
Thoracic Meningioma Masquerading as Chronic Abdominal Pain
Mark LYONS1, Elizabeth WINDGASSEN2, Carolyn KINNEY3, Daniel JOHNSON4, Barry BIRCH1, Orland BOUCHER1
1Mayo Clinic Arizona, Department of Neurological Surgery, Phoenix/AZ, USA
2Mayo Clinic Arizona, Department of Internal Medicine, Phoenix/AZ, USA
3Mayo Clinic Arizona, Department of Physical Medicine and Rehabilitation, Phoenix/AZ, USA
4Mayo Clinic Arizona, Department of General Surgery, Phoenix/AZ, USA
DOI : 10.5137/1019-5149.JTN.3567-10.0 Chronic abdominal pain without a structural or metabolic gastroenterological etiology can be extremely challenging to diagnose. Patients presenting with an associated radicular pattern of pain may alert the clinician to a possible structural neurological cause of the symptoms. We present the case of a 70-year-old woman who presented to our institution with an 18-month history of right upper quadrant abdominal pain. She had no associated symptoms or provoking factors. She underwent an extensive gastroenterology evaluation, including colonoscopy that was unrevealing. Ultrasound demonstrated gallstones and she was evaluated for cholecystectomy. She subsequently developed right costal margin pain. Her symptoms remained stable over the course of the next year. Follow-up general surgical evaluation was still unconvincing that the gallstones were the etiology of her symptoms. A thoracic spinal MR demonstrated a large intradural extramedullary mass at T8. The patient's neurological exam was normal. She underwent a thoracic laminectomy and resection of meningioma with intraoperative electrophysiological monitoring. Her abdominal pain resolved. Patients can present with months to years of elusive abdominal symptoms only to be eventually found to be harboring an undiagnosed spinal tumor. We discuss the case and review the literature reports of spinal tumors masquerading as chronic abdominal pain. Keywords : Thoracic meningioma, Spinal cord, Abdominal pain
Corresponding author : Mark Lyons, lyons.mark2@mayo.edu