Dr. Vivek Chail
General Practitioner
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have undiagnosed chest or back pain which over the last 4 to 5 months has been getting increasingly worse. Full spinal MRI performed, have not seen the report but was told by the doctor that there was nothing there that would account for the pain. I would really appreciate a fresh perspective.
Pain (4 to 7/10) behind left breast and radiating around the side and underarm. Not affected by posture or activity but unable to breathe deeply. Episodes last from 90 seconds to 4 to 5 hours, some days it only happens 2 to 3 times, other up to 20 times. Sometimes, the pain will wake me at night. This pain is different from other episodes in that it is much sharper (10/10) and makes lying down impossible. Cardiac causes and blood clots have been eliminated. Nuclear bone scan showed a hot spot at L1, which prompted a lumbar CT. From that, I was told that I have severe arthritis in the lumbar with possible nerve impingement. Advice from spinal MRI was no nerve impingement.
Previous history: Have confirmed the diagnosis of DISH in the neck (C3 to C7) and possible diagnosis of ankylosing spondylitis (being treated with Humira, which helps immensely). No problems with any other joints. Current medications: Mobic 15 mg once daily, Humira 40 mg fortnightly, Targin 40/20 mg twice daily, Endone 5 mg as required, Sevikar HCT 40/5/12.5 once daily, Thyroxine 200 mcg once daily, Oestradiol 2 mg once daily.
Comments: Have lost 5 cm in height in the last 5 to 6 years. Probably not relevant to my thoracic pain, but when I go to the toilet, most times I have severe lower back pain for some time after, and occasionally pain down the back of both thighs.
Hi,
Welcome to icliniq.com.
Following is the reply after viewing your images (attachment removed to protect patient identity).
Review of cervical spine MRI. In C2-C3 disc level, there is a mild left neural foraminal compromise. In C3-C4 and C4-C5 disc levels, there is minimal right and mild left neural foraminal compromise. In C5-C6 and C6-C7 disc levels, there is a minimal bilateral neural foraminal compromise (left greater than right). The features of DISH are persisting. Therefore, it is likely that the pains you are having on the left are due to mild neural foraminal compromise in the above cervical levels. There is mild fluid in C3-C4 and C4-C5 disc levels. There is no significant spinal canal stenosis. Review of thoracic spine MRI shows no significant disc bulge or neural foraminal compromise.
Review of lumbar spine MRI and CT. There is no obvious disc bulge but the changes in the vertebrae and the intervertebral facet joints are moderate in nature. There is thickening of the flavum ligamentum in L1-L2, L2-L3 and L3-L4 disc levels causing thecal sac compression and impingement of nerves in the lumbar spinal canal. There is lumbar spinal canal stenosis in many disc levels and is prominent in L1-L2 disc level.
There is a moderate bilateral neural foraminal compromise in L3-L4 and L4-L5 disc levels. The increase in pain during bowel movements is likely due to dynamic neural foraminal stenosis. The CT scan shows significant degenerative bone changes and facet joints are showing sclerotic changes in multiple levels.
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General Practitioner
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