Cystic Angiomatosis: A Rare Cause of Thoracic Radiculopathy: A Case Report.

Abstract

Thoracic radiculopathy is a rare condition that is most frequently attributed to thoracic disc disease and diabetes mellitus. It typically presents as pain, paresthesias, dysesthesias, and loss of sensation in a dermatomal distribution across the chest, thorax, and/or abdomen. Neoplasms, skeletal deformities (e.g., scoliosis, kyphosis, and compression fractures), and other skeletal and extraskeletal diseases encompass some of the numerous disease etiologies1-4. Cystic angiomatosis (CA), a disease characterized by cystic skeletal lesions with or without extraskeletal involvement, represents an even rarer cause of thoracic radiculopathy. CA is histologically described as cystic lesions of hemangiomatous, lymphangiomatous, or mixed origin. It typically presents in the first three decades of life4-6 with no sex preference7, and has an estimated incidence rate of between 0.1 and 1.0 in 1,000,0008. It most frequently presents with skeletal and extraskeletal lesions, but it also may present with isolated skeletal lesions5,9,10. The skull, ribs, vertebrae (cervical vertebrae most frequently)7, pelvis, femora, and humeri10,11 are the skeletal structures that are most commonly involved. The spleen, liver, kidneys, pleurae, and lungs represent the most commonly affected extraskeletal structures5,9,12. Skeletal lesions are most commonly located within the medullary cavity; however, cortical involvement has been noted13. CA tends to be diagnosed in asymptomatic individuals after routine radiographs reveal diffuse cystic skeletal lesions. Symptomatic patients may present with bone pain with or without pathological fractures, localized swelling and tenderness, dyspnea, hemoptysis, ascites, and even organ failure. While the lesions may spontaneously remit, patients are at risk for permanent deformity, loss of function, and even death—especially in patients with splenic14,15 or pleural involvement12,16 or infected angiomatic lesions11. …