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A splenic cyst causing a viscerosomatic reflex in the thoracic spine. A case report

Journal: International Journal of Osteopathic Medicine Date: 2021/03, 39(1):Pages: 21-25. doi: Subito , type of study: case report

Full text    (https://www.sciencedirect.com/science/article/pii/S1746068920302054)

Keywords:

case report [514]
osteopathic manipulative treatment [2973]
OMT [2951]
thoracic pain [4]
viscerosomatic reflex [4]
splenic cyst [1]

Abstract:

Introduction Musculoskeletal pain in the thoracic spine is a common complaint and often seen in the osteopathic clinic. An underlying cause may be pain originating from an internal organ referring to the segmental related somatic structures, i.e. a viscerosomatic reflex. A splenic cyst causing a viscerosomatic reflex in the thoracic spine is a rare but serious differential diagnosis for thoracic musculoskeletal pain that may be identified during routine osteopathic assessment and treatment. Case presentation A 36-year-old women was referred for osteopathy with pain in the thoracic spine as the main complaint. The pain was aggravated by twisting motions, prolonged standing and sitting. The physical examination identified hyperalgesia, hypertonic paraspinal muscles with trophic changes at T6-10 and hypomobility at T6-8. On palpation the diaphragm muscle was hypertonic. In the abdomen, a palpable mass was found in the left upper quadrant, which was suspected to be an enlarged spleen. A normal size spleen is not palpable; therefore, the patient was referred for further investigations. An X-ray and CT scan identified a splenic cyst of approximately 10 cm which was removed with a splenectomy as advised, leading to resolution of the thoracic pain. Conclusion A splenic cyst mimicking mechanical pain in the thoracic spine is rare; however, this case report highlights the importance of comprehensive history taking and screening of red flags, combined with careful physical examination of both musculoskeletal and visceral structures.


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