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Herpes Zoster Infection of the Chest Wall

Chest Wall Herpes Zoster


Presentation

  • Fig. 1. ( A ) Frontal view of the patient at the time of presentation. Note abdominal wall asymmetry. ( B ) Side view of the patient at the time of presentation. Fig. 1. ( A ) Frontal view of the patient at the time of presentation.[anesthesiology.pubs.asahq.org]
  • The algorithms presented in full guideline show the two diagnostic pathways.[nice.org.uk]
  • It is present in 13 to 36 percent of these patients, depending on the study and the patient setting. 1 - 3 , 6 In a prospective study of adult patients presenting to an emergency department with chest pain, 30 percent had costochondritis. 1 A prospective[aafp.org]
  • However, some patients present with only mild pain, often mistaken for a symptom of musculoskeletal condition ( 6 ).[docsopinion.com]
  • Presentation of herpes zoster on a male patient’s right chest wall. Last updated on: April 11, 2012[practicalpainmanagement.com]
Chest Wall Pain
  • wall pain may radiate to back and abdomen.[quizlet.com]
  • wall pain of varying intensity, typically described as sharp, aching, or pressure-like.[aafp.org]
  • Pain intensity decreased from 100 to 44.6%. 17 Otsuka found that therapeutic laser had similar effects on PHN as epidural or stellate ganglion blocks. 18 Case Discussion A 52-year old Hispanic male presented with severe chest wall pain on the right side[practicalpainmanagement.com]
Non-Cardiac Chest Pain
  • This Cochrane review included all studies of psychotherapy for non-cardiac chest pain. Seventeen trials met the inclusion criteria, and included a total of 1006 participants.[healthdirect.gov.au]
Chest Pain
  • Examination, Exercise Prescription, Diagnosis and Treatment of Osteoarthritis, Evaluation and Treatment of Cervical Radiculopathy, Choosing the Right Diagnostic Imaging Modality in Musculoskeletal Diagnosis, Evaluation and Treatment of Musculoskeletal Chest[books.google.de]
  • The guideline also recognises that in people with a prior diagnosis of coronary artery disease, chest pain or discomfort is not necessarily cardiac. The term 'chest pain' is used throughout the guideline to mean chest pain or discomfort.[nice.org.uk]
  • Read more on WA Health website Chest Pain myVMC Chest pain is one of the most commonly presented problems to the doctor.[healthdirect.gov.au]
  • Musculoskeletal Causes of Chest Pain 16. Musculoskeletal Chest Pain A large proportion of chest pain is caused by an underlying musculoskeletal condition.[docsopinion.com]
  • Less common causes of chest pain Some of the less common causes of chest pain include the following.[patient.info]
Back Pain
  • Spinal Cord Stimulation 1379 Motor Cortex and Deep Brain Stimulation 1392 Epidural Steroid Injections 1423 Intrathecal Drug Delivery in the Management of Pain 1437 Intradiscal Therapies for Low Back Pain 1458 SECTION F SURGICAL APPROACHES 1486 The Surgical[books.google.com]
  • Aortic dissection Patients with acute aortic dissection usually present with acute, severe, chest and back pain which is sharp and may have a ripping or tearing quality.[docsopinion.com]
Vesicular Rash
  • ., D.Phil. 7 Citing Articles A vesicular rash of the right T11–T12 dermatomes developed in a 75-year-old man.[nejm.org]
  • Physical examination revealed an erythematous vesicular rash along the T5 dermatome of her left hemithorax, crossing over her surgical scars to reach the edge of her reconstructed areola (Fig. 1).[journals.lww.com]
  • On the day of the in-patient admission the preoperative physical examination revealed a pruritic erythematous vesicular rash around the right trunk and the reconstructed right breast/latissimus dorsi skin flap.[e-aps.org]
  • Erythematous maculopapular lesions then appear and quickly evolve into a vesicular rash, nearly always in a unilateral dermatome, with no vesicles beyond the midline.[emedmd.com]
  • The disease begins with a prodrome of pain in the affected area for 1 to 3 days, followed by the outbreak of a maculopapular rash that quickly progresses to a vesicular rash.[barnardhealth.us]
Neuralgia
  • Motor Cortex and Deep Brain Stimulation 1392 Epidural Steroid Injections 1423 Intrathecal Drug Delivery in the Management of Pain 1437 Intradiscal Therapies for Low Back Pain 1458 SECTION F SURGICAL APPROACHES 1486 The Surgical Management of Trigeminal Neuralgia[books.google.com]
  • Postherpetic neuralgia The incidence of postherpetic neuralgia rises with the increasing age of the patient. It is uncommon in young people, but can occur in 50% of patients older than 50 years.[emedmd.com]
  • Laser therapy can be easily and economically utilized in the treatment of both acute phase herpes zoster and in chronic post-herpetic neuralgia.[practicalpainmanagement.com]
  • “We don’t know why some people get post-herpetic neuralgia and some don’t,” says pain management specialist Ellen King MD . “There’s plenty of speculation.[health.clevelandclinic.org]
  • Postherpetic neuralgia (PHN) This is the most common complication. It is where the nerve pain (neuralgia) of shingles persists after the rash has gone. This problem is uncommon in people aged under 50.[patient.info]
Hyperesthesia
  • We noted allodynia and hyperesthesia in these regions, and the left T5 dermatome revealed extreme sensitivity. THE DIAGNOSIS We decided to test for antibodies to the varicella-zoster virus (VZV) based on the location of the pain along a dermatome.[mdedge.com]
  • He also reported nearly complete resolution of the burning pain and hyperesthesia.[anesthesiology.pubs.asahq.org]
  • The pain was continuous, of moderate intensity, burning in nature, and associated with hyperesthesia. She had a painful vesicular eruption in the area of right breast extending up to the scapula, 12 months ago.[ijdvl.com]
  • This may result in arriving at an incorrect diagnosis. 4 These initial symp-toms are frequently followed by burning pain, itching, hyperesthesia or paresthesia. 5 The pain may be mild to extreme in the affected dermatome, with sensations that are often[practicalpainmanagement.com]
  • It is the most frequent complication of herpes zoster, observed in 9-45% of all cases. [4] Most people report a deep burning or aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains.[emedicine.medscape.com]
Radiculopathy
  • The Preparticipation Physical Examination, Exercise Prescription, Diagnosis and Treatment of Osteoarthritis, Evaluation and Treatment of Cervical Radiculopathy, Choosing the Right Diagnostic Imaging Modality in Musculoskeletal Diagnosis, Evaluation and[books.google.de]
  • MRI of the spine and nerve roots, though informative in lumbosacral radiculopathy 11 has not been studied in this context.[academic.oup.com]
Cervical Radiculopathy
  • The Preparticipation Physical Examination, Exercise Prescription, Diagnosis and Treatment of Osteoarthritis, Evaluation and Treatment of Cervical Radiculopathy, Choosing the Right Diagnostic Imaging Modality in Musculoskeletal Diagnosis, Evaluation and[books.google.de]
Nystagmus
  • The patient may experience hearing impairment, nystagmus, vertigo, or a facial nerve palsy mimicking Bell palsy. [16] Patients may lose taste sensation in the anterior two thirds of the tongue. [ 16 ] Clinical phases of disease The clinical manifestations[emedicine.medscape.com]

Workup

  • Further workup included thoracic spine magnetic resonance imaging, which revealed no evidence of nerve root impingement that might explain the thoracic nerve root symptoms.[anesthesiology.pubs.asahq.org]
  • Patients are usually admitted to the coronary care unit (CCU) for observation, further workup, and treatment. Although the function of the heart muscle may be severely affected during the initial phase, recovery is usually complete.[docsopinion.com]
  • Treatment options include injection of local anaesthetic at aponeurotic foraminae and neurectomy. 10 Diagnostic workup After excluding diabetes, the clinician should look for the presence of other neuropathy.[academic.oup.com]
  • […] fluorescent antibody (DFA) testing of vesicular fluid or a corneal lesion Polymerase chain reaction (PCR) testing of vesicular fluid, a corneal lesion, or blood Tzanck smear of vesicular fluid (lower sensitivity and specificity than DFA or PCR) See Workup[emedicine.medscape.com]

Treatment

  • Treatment of Musculoskeletal Chest Pain, Evaluation and Treatment of Rotator Cuff Pathology, Evaluation and Treatment of Sternoclavicular, Clavicular, and Acromioclavicular Injuries, Evaluation and Treatment of Upper Extremity Nerve Entrapment Syndromes[books.google.de]
  • […] followed by multiple choice questions in established SOAP (Subjective, Objective, Assessment, and Plan) format through which students explore relevant aspects of patient history, physical examination, and diagnostic studies to determine diagnosis and treatment[books.google.com]
  • The book concludes with discussions of the provision of pain treatment in a variety of clinical settings, including pain clinics, spine clinics, the primary care setting, the emergency department, the intensive care unit, and end-of-life care.[books.google.com]
  • Help is available Fortunately, early treatment for shingles can lower your chances of getting PHN. “For some people, the pain becomes refractory, or resistant to treatment,” explains Dr. King.[health.clevelandclinic.org]
  • It can be severely painful and resistant to conventional treatment.[practicalpainmanagement.com]

Prognosis

  • Segmental motor weakness is an uncommon complication that occurs in 3 to 5 percent of patients with herpes zoster and is associated with a good prognosis for recovery. N. Troy Tagg, M.D. Jack W. Tsao, M.D., D.Phil.[nejm.org]
  • Context Conditions causing chest pain or discomfort, such as an acute coronary syndrome or angina, have a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis.[nice.org.uk]
  • Erkrankungen des Zwerchfells 276 Zwerchfellcysten 283 References 324 Surgical treatment of ventricular septal defects By C CRAFooRD and W O B JöRK With 351 B Pathophysiology 387 Diagnosis 399 Patent ductus arteriosus By G EKSTRöM With 22 Figures 439 The prognosis[books.google.de]
  • J Bone Joint Surg Am 1961; 43A: 885–96Grant, BD Rowe, CR Gupta SK, Helal BH, Kiely P: The prognosis in zoster paralysis.[anesthesiology.pubs.asahq.org]
  • The prognosis for younger and otherwise healthy patients is excellent. Elderly people have a significantly increased risk of complications.[emedicine.medscape.com]

Etiology

  • Some authors believe that recurrent zoster is an extremely uncommon event and most of the cases clinically diagnosed to be recurrent herpes zoster turned out to be zosteriform herpes simplex on confirming the etiological agent. [3] Recurrence of zosteriform[idoj.in]
  • Viral etiologies include enteroviruses (coxsackie, echovirus, and poliovirus), as well as mumps, influenza virus, and Varicella zoster. An emerging cause is HIV-associated myocarditis and chronic Epstein-Barr myocarditis.[barnardhealth.us]
  • The pain can be severe and incapacitating, and may take a long time to resolve, especially in the elderly; it lasts longer than 12 months in nearly 50% of patients older than 70 years. [ 5 ] Etiology Herpes zoster is caused by VZV infection.[emedicine.medscape.com]

Epidemiology

  • The correct response for each step in the case is provided along with evidence-based explanations and epidemiological data.[books.google.com]
  • Epidemiology United States statistics In the United States, approximately 95% of adults—and 99.5% of adults aged 40 years or older—have antibodies to VZV and thus are vulnerable to reactivation of infection. [41] A person of any age with a previous varicella[emedicine.medscape.com]
  • Thus, cervical or shoulder problems may refer pain to the chest wall. 2 Epidemiology Costochondritis can affect children as well as adults.[aafp.org]
  • Epidemiology VZV infects only humans, which are thus the only reservoir. The virus is presumed to spread by the respiratory route.[emedmd.com]
Sex distribution
Age distribution

Pathophysiology

  • Erkrankungen des Zwerchfells Von F KOSS und H REITTER unter Mitarbeit von K 191 Entzündliche Erkrankungen des Zwerchfells 276 Zwerchfellcysten 283 References 324 Surgical treatment of ventricular septal defects By C CRAFooRD and W O B JöRK With 351 B Pathophysiology[books.google.de]
  • Pathophysiology VZV infection gives rise to 2 distinct syndromes. The primary infection, chickenpox, is a contagious and usually benign febrile illness.[emedicine.medscape.com]

Prevention

  • Shingles is a highly preventable disease. The most important prevention method is the shingles vaccine or herpes zoster vaccine (Zostavax). This vaccine cuts the risk of the disease in half .[healthline.com]
  • Other than the vaccine, there is no way of preventing shingles for somebody who has had chickenpox in the past.[patient.info]
  • Centers for Disease Control and Prevention.[emedicinehealth.com]
  • These medicines may also help prevent lingering pain. A vaccine may prevent shingles or lessen its effects. The vaccine is recommended for people 60 or over. In some cases doctors may give it to people ages 50 to 59.[fpnotebook.com]
  • Prevention and control Varicella–zoster immune globulin, prepared from high-titre immune human serum, has been shown to prevent or ameliorate varicella in seronegative people at high risk, such as immunocompromised people and pregnant women.[emedmd.com]

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