Intercostal Neurinoma: A Rare Cause of Persistent Thoracic Pain

Abstract

Persistent thoracic pain with no history of trauma demands diagnostic workup. In this case, the patient complained of right thoracic continuous belt-like pain, sometimes experienced as shooting pain, over several months. The symptoms were first treated conservatively with painkillers, which was rather ineffective. A magnetic resonance imaging scan of the thorax surprisingly showed an unclear piston-like enlargement near the seventh rib closely above the spinal canal. Video thoracoscopy was performed to provide further clarification. This showed two lesions of the intercostal nerves of the seventh and eighth ribs. The intercostal nerves were resected in these areas. Histological examination revealed two neurinomas of the intercostal nerves with focal outgrowth of a neural cyst measuring 1.6 cm on the seventh intercostal nerve. The patient was free of any pain after the operation.

Keywords

thoracic surgery - chest wall - thoracoscopy/VATS

• References

• 1 McClenathan JH, Bloom RJ. Peripheral tumors of the intercostal nerves. Ann Thorac Surg 2004; 78 (2) 713-714
• 2 Bicakcioglu P, Demirag F, Yazicioglu A, Aydogdu K, Kaya S, Karaoglanoglu N. Intrathoracic neurogenic tumors. Thorac Cardiovasc Surg 2014; 62 (2) 147-152
• 3 Weder W, Schlumpf R, Schimmer R, Kotulek T, Largiadèr F. Thoracoscopic resection of benign schwannoma. Thorac Cardiovasc Surg 1992; 40 (4) 192-194
• 4 Satoda N, Hijiya K, Fukuse T. Two-port video-assisted thoracoscopic excision of an intercostal schwannoma [in Japanese]. Kyobu Geka 2004; 57 (3) 198-200
• 5 Li Y, Wang J. Experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumours: a retrospective analysis of 58 patients. ANZ J Surg 2013; 83 (9) 664-668
• 6 Tang H, Wu L, Li J, Liu H, Xu Z. Multiple schwannomas in a single costal interval: report of two cases. J Neuroimaging 2011; 21 (3) 290-291