Thoracic meningioma masquerading as chronic abdominal pain.
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.
Mayo Clinic Arizona, Department of Neurological Surgery, Phoenix, AZ, USA. lyons.mark2@mayo.edu
Mark
M
Lyons
Elizabeth
E
Windgassen
Carolyn
C
Kinney
Daniel
D
Johnson
Barry
B
Birch
Orland
O
Boucher
D015746:Abdominal Pain / Q000209:etiology* / Q000473:pathology*; D000368:Aged; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000150:complications* / Q000473:pathology*; D008579:Meningioma / Q000150:complications* / Q000473:pathology*; D013904:Thoracic Vertebrae