Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Strebel, B. M. Articles by Ross, S. Search for Related Content PubMed PubMed Citation Articles by Strebel, B. M., MD Articles by Ross, S., MD Related Collections Pain Related Articles

Chronic post-thoracotomy pain syndrome

Bruno M. Strebel, MD^* and Steffen Ross, MD

*Department of Internal Medicine; Institute of Radiology, Cantonal Hospital of Munsterlingen, Munsterlingen, Switzerland

What's your call?

Three-dimensional reconstruction of a chest computed tomography scan of a 60-year-old woman with acute and chronic chest pain localized to the region of a 10-year-old thoracotomy scar.

The 3-dimensional reconstruction of the computed tomography scan was obtained at the time of admission to exclude pulmonary embolus and aortic dissection. It confirmed a narrowing of the fifth intercostal space (Figure 1) where the thoracotomy had taken place. Pain was believed to be related to an entrapment of the fifth intercostal nerve or chronic periostitis due to bone-on-bone contact between the fifth and sixth ribs, or both. Lasting pain relief followed selective neurolysis of the fifth intercostal nerve.

View larger version (142K): [in this window] [in a new window]   Figure 1: Three-dimensional reconstruction of helical chest computed tomography scan shows close contact between fifth and sixth ribs (arrows).

Chronic post-thoracotomy pain syndrome is defined as pain that recurs or persists along a thoracotomy incision for at least 2 months following surgery. It can occur in more than 50% of cases.¹ Multiple mechanisms leading to chronic post-thoracotomy pain syndrome have been proposed, including poorly repositioned rib fractures, costochondritis, costochondral dislocation, intercostal neuroma, nerve entrapment and local infection.² Treatment is guided by the underlying cause, which in many cases is not clear.

	Footnotes

 
This article has been peer reviewed.

Competing interests: None declared.

	REFERENCES

Top REFERENCES

 

1. Pluijms WA, Steegers MAH, Verhagen AFTM, et al. Chronic post-thoracotomy pain: a retrospective study. Acta Anaesthesiol Scand 2006;50:804-8.[CrossRef][Medline]
2. Rogers ML, Duffy JP. Surgical aspects of chronic post-thoracotomy pain. Eur J Cardiothorac Surg 2000;18:711-6.[Abstract/Free Full Text]

This Article Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Strebel, B. M. Articles by Ross, S. Search for Related Content PubMed PubMed Citation Articles by Strebel, B. M., MD Articles by Ross, S., MD Related Collections Pain Related Articles

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2007, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.