Ultrasound-guided radiofrequency ablation in a patient with resistant intercostal neuralgia secondary to chronic osteomyelitis of anterior end of ribs

Abstract

Intercostal neuralgia is a complex painful disorder characterized by intense, sharp shooting, or burning pain, along the distribution of intercostal nerve. It is difficult to treat condition in which pharmacological modalities of treatment often fail. We report a case of a 56-year-old female with postoperative sternal wound infection, following coronary artery bypass grafting, involving the left costochondral junction and left anterior ends of 7th, 8th, and 9th ribs. She presented with severe excruciating pain over left T7, T8, and T9 dermatomes for 3 months. Conservative management failed to provide significant improvement in pain relief. Hence, intercostal nerve block was performed and it provided good pain relief for 3 weeks. It was then followed by radiofrequency ablation (RFA) that provided good symptomatic pain relief at 9-month follow-up. Thus, ultrasound-guided RFA can be effectively and safely used in patients suffering from resistant intercostal neuralgia for providing quick and long-term pain relief.

Keywords

• deep sternal wound infections
• intercostal neuralgia
• osteomyelitis of rib
• ultrasound-guided radiofrequency ablation