T11 Hemangioma, please help!

Hi, I have been suffereing with low back and low thoracic pain for 26 years with the pain gradually getting worse as time passed.The pain in both areas differs. Low back is like a knife slicing from side to side, radiating into my hips making my legs feel heavy and my buttocks sore. The low thoracic pain is like a burning, tingling pain that radiates through my ribs to the front of my chest making it difficult to breath sometimes. I hurts to lay on either side and my low back starts to hurt if I lay flat on my back so I wake every time I have to turn over. I have pain when the areas are touched and when it gets really bad it makes me feel sick. I take Tramadol x8 a day, paracetamol x8 a day and diclofenac x3 a day which only takes the edge off the pain and I can only walk or stand for 10 minutes at a time before the pain kicks in really bad. I have recently had an MRI done and it said:

'Minor disc de-hydration is seen in the lumbar spine with preservation of disc height. Minor central disc bulge is seen at L4 - 5 and L5 - S1 levels and L2 - 3 levels but no significant neurologic compromise is seen. No eveidence of spinal stenosis seen. There is mild to moderate facet osteoarthritic change is noted. The distal cord and cauda equina are normal. No significant focal bone marrow lesion is seen in part fro a hemangioma in T11 vertebra.'

These are the exact words written on a report by a consultant radiologist.

I have seen a neurologist and a pain management dr and both said that the hemangioma would not pose a problem but I beg to differ.

My question is that the pain that I suffer in the thoracic area is in the exact spot of the hemangioma but why won't the doctors believe me?

Please help. All I want is some quality of life back. I don't think that is too much to ask.

Carol

[Kalvin]

Hemangiomas can be symptomatic, and when they are, they can affect the vertebra in its entirety, causing fractures, compressing nerves, narrowing the spinal canal and compressing the cord. If there was the slightest evidence that yours was encroaching on the nerves or thecal sac, the radiologist would have definitely noted it. I’m not saying that you don’t experience pain at T11, I’m sure you do, but it could be related to your facet joint problems or your small disc bulge at L2-3. That’s not that far away from T11.

The pain you describe in your mid-back and the banding indicate that its a nerve problem, each level in the spine has a specific dermatome, or band. In most people, T4 is the nipple area, T10 is the belly button area, T11 is even lower. It’s highly unlikely that this pain is originating at T11; I guess it’s possible, just not likely. You could be experiencing these pains simultaneously, that happens. However, lesions that far down in the T-spine are often difficult to differentiate between disorders of lumbar spine.

One way of seeing if this pain originates at T11 would be to have your doctor perform medial branch block over the corresponding area, if it stops the mid-back and chest pain, then you were right all along.

The reason I know a little bit about this is because I have the same mid-back and chest pain as you, and yes it’s awful. It originates in the mid-thoracic, that’s why I asked if you had a T-spine MRI, because there’s a good chance you have a problem there. Your low back pain is consistent with Facet Joint Syndrome. Typical symptoms are:

Pain or tenderness in the lower back
Pain that increases with twisting or arching the body
Pain that moves to the buttocks or the back of the thighs — This pain is usually a deep, dull ache.
Stiffness or difficulty with certain movements, such as standing up straight or getting up out of a chair

Take Care

[Kalvin]

Was this hemangioma discovered during the course of your lumbar MRI, have you ever had an Thoracic MRI?

You wrote that you have pain in the exact spot that the hemangioma is, does the pain then radiate up into your mid back and chest?

[Nutty_tart]

Thanks for replying.Yes it was discovered during a lumbar MRI and no I haven't been offered a thoracic MRI but I should ask the neurologist in october to do one.

Yes, the pain goes up my mid back like a band and also goes round the ribs to the front of my chest and down to join the lumbar pain.  It is like pins and needles, tingling and burning to the extreme. Also, it hurts when I lay on either side. Sometimes it hurts to breathe, especially on a bad day, then the pain makes me sick.

[Kalvin]

Hemangiomas can be symptomatic, and when they are, they can affect the vertebra in its entirety, causing fractures, compressing nerves, narrowing the spinal canal and compressing the cord. If there was the slightest evidence that yours was encroaching on the nerves or thecal sac, the radiologist would have definitely noted it. I’m not saying that you don’t experience pain at T11, I’m sure you do, but it could be related to your facet joint problems or your small disc bulge at L2-3. That’s not that far away from T11.

The pain you describe in your mid-back and the banding indicate that its a nerve problem, each level in the spine has a specific dermatome, or band. In most people, T4 is the nipple area, T10 is the belly button area, T11 is even lower. It’s highly unlikely that this pain is originating at T11; I guess it’s possible, just not likely. You could be experiencing these pains simultaneously, that happens. However, lesions that far down in the T-spine are often difficult to differentiate between disorders of lumbar spine.

One way of seeing if this pain originates at T11 would be to have your doctor perform medial branch block over the corresponding area, if it stops the mid-back and chest pain, then you were right all along.

The reason I know a little bit about this is because I have the same mid-back and chest pain as you, and yes it’s awful. It originates in the mid-thoracic, that’s why I asked if you had a T-spine MRI, because there’s a good chance you have a problem there. Your low back pain is consistent with Facet Joint Syndrome. Typical symptoms are:

Pain or tenderness in the lower back
Pain that increases with twisting or arching the body
Pain that moves to the buttocks or the back of the thighs — This pain is usually a deep, dull ache.
Stiffness or difficulty with certain movements, such as standing up straight or getting up out of a chair

Take Care

[Nutty_tart]

Thank you agin for your answer. It has made me think now, could I have a hemangioma further up the T spine that is causing this pain. When I measure where the pain is and where it radiates to in the chest it is about 2 inches below my breasts, not being very good at anatomy, what area of the T spine do you think that is?

You have decribed the lumbar pain perfectly, everything you said, I am experiencing.

I am due to have facet joint steroid injections on the 10th Sept 2010, not looking forward to it but have to be showing willing and trying everything that pain management wants to do.I also have another appointment with a neurologist in october 2010 and he is going to review me. I am now wondering if I should request a T spine MRI to check what the pain is.

What do you think?

Thanks again
Carol

[Kalvin]

I wasn't exactly sure how you would react to my saying that I didn't think your mid-back and chest pain was caused by your hemangioma at T11, I didn't know if you might be angry or offended. I'm glad you weren't.

The area you describe would be somewhere between T3-6. Do a search for "Dermatome Maps" on the internet, then you can see for yourself. Hemangioma's aren't that common and I doubt if you have another one. The pain your having is probably being caused by a disc bulge or a bone spur. It might even be caused by a dysfunction of the costovertebral joint, which is where the ribs attach to the vertebra,  problems here are common.

Ideally, when you had your facet joint injections, they could do a similar epidural  in your mid-back. These injections are diagnostic as well as for pain. You might want to ask your Neurologist to let you try Gabapentin, which is an anticonvulsant, but it is also widely used for nerve pain (burning and tingling), it will make you extremely tired, but it might help. Is the paracetamol helping you at all, if not I would stop using it. That much is bad for your liver.

As far as your low back, you have text book symptoms for Facet Joint Syndrome, why has it taken so long for them to diagnose you?  I hope the injections help and I hope they help you with your thoracic pain too.

I know what its like to be in pain day after day, it's very tiring, and dealing with a lot of these Doctors isn't exactly a pleasant experience either.


Take Care

[Nutty_tart]

Hi, I certainly wasn't offended, just the fact that someone else could help made me feel a lot happier, so thank you.
Carol