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August 1986

Diabetic Thoracoabdominal Neuropathy: A Cause for Chest and Abdominal Pain

Author Affiliations

Department of Neurology Baylor College of Medicine and Veterans Administration Medical Center Houston, TX 77030

Arch Intern Med. 1986;146(8):1493-1494. doi:10.1001/archinte.1986.00360200043004

Neuropathies of peripheral, autonomic, and cranial nerves are well-known complications of diabetes mellitus.1 However, diabetic thoracoabdominal neuropathy (TAN) syndrome and its clinical presentations and diagnostic criteria have not been widely recognized. This entity manifests primarily as pain along single or multiple intercostal nerves and may mimic thoracic and/or abdominal visceral pathology (eg, coronary artery disease, gallbladder disease, acute appendicitis).2-8 Unless the diagnosis is made early, the patient may be unnecessarily subjected to extensive, expensive, and often invasive procedures.

The clinical picture of diabetic thoracoabdominal neuropathy is very characteristic.2-8 The condition usually presents in the fifth or sixth decade of life. While most patients with TAN have type II diabetes, there is no relationship between the duration of disease and the type of diabetic treatment. In most cases the presenting complaint is burning pain in a dermatomal distribution, usually of gradual onset and often intensified at night. Patients

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