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Thoracic Disc Herniation Presenting with Chronic Nausea and Abdominal PainA Case Report
Rachel S. Rohde, MD1; James D. Kang, MD1
1 Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1010, 3741 Fifth Avenue, Pittsburgh, PA 15213.
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Feb 01;86(2):379-381
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The incidence of symptomatic thoracic disc herniation has been reported to be one per million per year1. Most patients present with either pain in the chest wall, usually in the distribution of a thoracic nerve root dermatome, or thoracic myelopathy involving the lower extremities. However, on rare occasions, other symptoms that might be suggestive of a shoulder, cardiothoracic, abdominal, or pelvic abnormality may be the presenting complaints1-5. Such symptoms may spur an extensive workup for other disease processes before a patient is referred to a spine specialist, often as much as a year after the onset of symptoms. The serious consequences of a late or missed diagnosis necessitate that a symptomatic thoracic disc herniation, particularly one accompanied by neurological compromise, be addressed as soon as possible; therefore, recognition of atypical presentations is important. We report the case of a forty-one-year-old woman with an eight-month history of nausea and abdominal pain. Magnetic resonance imaging of the thoracic spine showed a large central disc herniation at the T9-T10 level. To our knowledge, this is the first report of a patient with a thoracic disc herniation who presented with chronic nausea and abdominal pain. The patient was informed that information concerning this case would be submitted for publication.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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