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Chronic pseudo-angina left precordial chest pain caused by a thoracic meningioma
Eric Azabou1,2, Vincent Kumako2, Mahmoud Al Moussawi2
1Service de Physiologie-Explorations Fonctionnelles, Hôpital Raymond Poincaré, Assistance Publique - Hôpitaux de Paris, INSERM CIC-IT 805, EA 4497, Université de Versailles St Quentin-En-Yvelines, 92380 Garches, France.
Insights
When cardiac, pulmonary, or digestive issues are ruled out for left precordial chest pain (LPCP), consider spine magnetic resonance imaging. This case highlights thoracic meningioma as a cause of chronic angina-like LPCP.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Left precordial chest pain (LPCP) is often initially attributed to cardiac causes like angina.
- When cardiac, pulmonary, and digestive origins are excluded, identifying the cause of persistent chest pain is crucial.
- A wide spectrum of non-cardiac conditions can mimic cardiac pain, including neurological and musculoskeletal disorders.
Purpose of the Study:
- To highlight the diagnostic utility of spine magnetic resonance imaging (MRI) in cases of undifferentiated left precordial chest pain.
- To report a case where thoracic meningioma presented as chronic angina-like LPCP.
Main Methods:
- Clinical evaluation of chronic angina-like left precordial chest pain.
- Exclusion of cardiac, pulmonary, and digestive etiologies.
- Magnetic resonance imaging (MRI) of the thoracic spine.
Main Results:
- A thoracic meningioma was identified as the cause of the patient's chronic angina-like left precordial chest pain.
- Spine MRI proved essential in diagnosing this rare, non-cardiac cause of chest pain.
Conclusions:
- In patients with left precordial chest pain where common causes are excluded, thoracic spine pathology should be investigated.
- Spine MRI is a valuable tool for diagnosing neurological conditions presenting as chest pain, such as meningioma.
Abstract:
Left precordial chest pain (LPCP) evokes above all angina. Eliminating a cardiac origin is then always the first priority. When cardiac causes are eliminated, non-cardiac causes are sought in order to avoid leaving patients with undiagnosed or undifferentiated chest pain. There is a myriad of non-cardiac causes ranging from heartburn, panic attacks, pleurisy, pulmonary embolism, pneumothorax, Tietze syndrome, bruises and fractures of the ribs, to spine meningioma, neuroma, herniated disk and impairment of the nerve roots. Although clinical presentation and characteristics of the pain are usually helpful in diagnosing the cause, conducting magnetic resonance imaging of the spine may be of a high utility in some situations. Here we report a case of chronic angina-like LPCP, caused by a thoracic meningioma. <Learning objective: In cases where no cardiac, pulmonary, or digestive causes were detected, the management of left precordial chest pain should definitely include spine magnetic resonance imaging.>.
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Assessment:
1. Clinical Evaluation:
History: