ongoing chest and back pain

Hi! I am very frustrated at this point. I am 42y/o female. I have been having mid chest/back  pain or discomfort for about 31/2 months. The pain is very hard to describe. The raditation to my shoulders and back I can tolerate but when it also hurts in my chest, I can't stand it! I have no nausea, vomiting or SOB. I have had a cardiac workup including a CTA but all have been clear. The pain it transient such that I may have it for 3 weeks solid but then get a week break. During my week off I feel great! unfortunately it always comes back. It does not seem to be related to any particular food or activity. I was diagnosed this year with 2 liver adenomas that are being followed but I was told these should not cause pain. (I have felt some wrap around right sided pain that I contribute to these tumors) This pain is different. I have had several MRIs, CTs US etc.all related to these tumors and nothing else was spotted. A hida scan about 8 months ago said I had an EF of 34%. My question is: What specifically can cause chest pain with radiation to shoulders and back besides heart? My GI doc has taken a wait and see approach but he's not having the pain! I have had some vague right lower quadrant pain. What could cause that? Could they be related? Can you have a dysfunctional gallbladder without the typical nausea and vomiting? (I don't have stones). Please give me something to go on. Thanks!

[Kevin Pho, MD]

I agree with the workup thus far, and it has been comprehensive.  

To answer your questions:
1) Gallbladder disease can lead to radiation of the shoulders.  That being said, you have had ultrasounds and CT scans that have evaluated for many possible causes.  You can consider an MRCP to evaluate the biliary tree as well as Sphincter of Oddi manometry that can evaluate for Sphincter of Oddi dysfunction.

2) A dysfunctional gallbladder can lead to nausea and vomiting.  There are studies that say that removing the gallbladder can help in cases of a low gallbladder ejection fraction.

You can discuss this possibility with a surgeon.

If an upper endoscopy hasn't been done, I would consider this to evaluate for upper GI disease.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com