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Thoracoabdominal Neuropathy

Michael M. Ritter, MD; Werner O. Richter, MD; Peter Schwandt, MD
Arch Intern Med. 1988;148(7):1663. doi:10.1001/archinte.1988.00380070137034.
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To the Editor.  —Thoracoabdominal neuropathy has been described as a cause for chest pain in diabetic patients.1 This syndrome usually occurs in the fifth or sixth decade of life. We would like to call attention to another cause of strong thoracic pain that also occurs in young patients with diabetes mellitus.

Report of a Case.  —A 17-year-old boy with a two-year history of diabetes mellitus complained of a very intense, dull, constant pain in the upper anterior thoracic region, radiating to both shoulders. There was no association with movement or breathing. A physical examination was unremarkable with normal blood pressure, auscultatory findings, and abdominal tenderness. Emergency procedures (electrocardiogram and roentgenogram of the chest) were not helpful for diagnosis. Intravenous administration of opiates did not relieve the thoracic pain. Further examinations of the serum glucose concentration (12.8 mmol/L [230 mg/dL], the urine (ketone bodies, 3+), and of arterial blood pH


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