Case 7-2017

Abstract

PRESENTATION OF CASE A 77-year-old woman was seen in the outpatient neurology clinic at this hospital because of chronic thoracic pain. The patient had had constant pain under her left breast for as long as she could remember, probably since adolescence, which worsened over time and spread horizontally to involve a band on the entire left side of the chest. Multiple evaluations performed at other hospitals throughout her adult life had been unrevealing. Eight years before this evaluation, magnetic resonance imaging (MRI) of the spine was reported as normal, with an incidental finding of small cysts associated with neural foramina on the right side. One thoracic injection and three lumbar epidural injections of local anesthetic agents and glucocorticoids administered 2 years before this evaluation had only transiently improved the pain. Four months after the injections, MRI reportedly revealed a lesion (10 mm in the greatest dimension) in the left T7–T8 neural foramen, causing mild expansion and remodeling of the foramen; these findings were consistent with a perineurial cyst. One month later, a second MRI of the thoracic spine, performed with contrast material, reportedly revealed bilateral T7–T8 neural foraminal cysts measuring up to 8 mm in the greatest dimension and smaller foraminal lesions, suspected to be bilateral, at T10–T11, T11–T12, T12–L1, and low cervical levels. A radiograph of the chest revealed slight aortic dilatation.