Rib Discomfort and Asymmetry Issues
I’m an 18-year-old female, 5 feet tall, weighing 110 pounds, and currently a smoker. I have been diagnosed with hypermobile Ehlers-Danlos Syndrome, vasovagal syncope with orthostatic intolerance, and Raynaud’s phenomenon, and there is a possibility I have endometriosis. Earlier this year, I experienced a shoulder subluxation in April and have a history of long-standing costochondritis. My medication regimen includes ibuprofen, Midol, lidocaine, and vitamin D supplements. For more than a month, I’ve been dealing with discomfort on the left side of my ribs. This started after I maintained poor posture for an extended period. I experienced a sudden wave of intense pain that subsided within about 30 seconds. A few weeks later, I became aware that my ribs appeared uneven as well. I had an X-ray taken, which showed normal results. However, due to increasing pain over the last three days, I decided to visit urgent care to ensure everything was alright. On a pain scale from 1 to 10, I’d rate my discomfort at about 2 to 3. It’s not excruciating but is quite bothersome. My ribs make clicking sounds when I take deep breaths, twist my torso, bend, or sometimes even while sitting still. Engaging in any of these movements or applying pressure to my ribs intensifies the discomfort, which is an uneasy sensation that makes me feel restless. Additionally, I occasionally experience a peculiar glittery sensation beneath my ribs. The doctor noted that my ribs are asymmetrical, with the left side appearing swollen and elevated. He does not suspect dislocation, and he provided lidocaine to manage the discomfort, although I haven’t tried it yet. I’m currently relying on ibuprofen to reduce inflammation. The doctor mentioned that the issue could stem from several factors, including costochondritis. My past experiences with costochondritis felt different, affecting another area, but he believes this might be related to my hEDS condition. He expressed no concerns about my lung health and recommended I follow up with my primary care physician. I plan to reach out to my PCP tomorrow to see if I can schedule an earlier appointment for a follow-up. Apologies if this post strays from the standard guidelines or seems overly intricate for this platform. My health journey has been quite unpredictable.
Answers (1)
7/9/2025, 3:30:57 AM
OpenHealth AI
Thank you for sharing your detailed health concerns. It's understandable to feel uneasy with the discomfort you're experiencing, especially given your complex medical history. It sounds like you're dealing with several intertwined issues related to your hypermobile Ehlers-Danlos Syndrome and past musculoskeletal challenges.
Main Points:
- Current discomfort near your ribs may be related to your EDS or costochondritis.
- Your rib asymmetry and clicking sounds are concerning but may not indicate serious problems.
- Managing your pain and discomfort should be prioritized.
Explanation:
Rib discomfort, especially in your case with a history of costochondritis and hypermobile Ehlers-Danlos Syndrome (hEDS), can stem from musculoskeletal issues. Your body might be prone to increased strain or injury in these areas due to the nature of your connective tissue disorder. The asymmetry and inflammation you describe could be due to muscle strain or inflammation in the cartilaginous areas around your ribs, which is common in costochondritis.
The clicking sounds and the “glittery” sensation could indicate some irritation or instability, which can occur with hEDS. Since your X-ray is normal, that’s reassuring, but it’s essential to manage your symptoms effectively.
Prioritized Next Steps:
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Try the Lidocaine: Start using the lidocaine provided by your doctor to help manage your discomfort. Apply as directed and monitor how it affects your pain.
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Manage Pain with Ibuprofen: Continue taking ibuprofen as needed for pain and inflammation, but ensure it’s within the recommended dosages. If you have specific side effects or concerns with long-term use, discuss these with your PCP.
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Posture and Physical Care: Focus on maintaining good posture, especially when sitting or working. Consider gentle stretches or exercises that promote rib mobility and relaxation. Avoid positions that exacerbate your discomfort.
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Document Symptoms: Keep a journal of your symptoms, noting any activities that worsen or relieve the pain. This information can be beneficial for your upcoming appointment with your primary care physician.
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Follow-Up with Your PCP: It’s good to arrange for an earlier appointment with your primary care physician as planned. They can offer further evaluation and possibly refer you to a physical therapist who specializes in hypermobility and chronic pain management.
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Avoid Straws and Tight Clothing: These can sometimes exacerbate rib discomfort due to unnecessary pressure on the ribcage.
While it’s natural to worry about your symptoms, try to focus on these actionable steps to help manage your discomfort. Remember, addressing your posture and how you support your body can significantly impact your overall well-being. Please keep me updated on your progress or if you need additional support!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.