Management of post-thoracotomy pseudoangina and myofascial pain with botulinum toxin

LEFT brachial plexus injury and musculoskeletal pain have been reported after left internal mammary (LIMA) harvesting for left anterior descending coronary artery bypass grafting. Prolonged elevation and retraction of the left hemithorax with the Favoloro sternal retractor during LIMA harvesting has been implicated as a cause of left upper extremity peripheral neuropathy from brachial plexus stretch injury and postoperative musculoskeletal pain from rib fracture, intercostal muscle disruption, and costotransverse and costosternal cartilage separations. We report a case of factitious pseudoangina from prolonged postoperative musculoskeletal pain treated as angina pectoris with nitrates and anticoagulants after LIMA harvesting for left anterior descending coronary artery bypass grafting (table 1).