Unusual clinical complication: Acute lower limb ischemia caused by a tibial osteochondroma

Vascular complications of tibial exostosis: A rare case of popliteal vein deep venous thrombosis

INTRODUCTION AND IMPORTANCE

Tibial exostosis (osteochondroma) represents a prevalent benign bone tumor typically identified in young adults. Uncommonly, vascular complications can emerge, encompassing vessel perforation, thrombosis and arterial thromboembolic events. Rare instances of popliteal vein thrombosis resulting from tibial osteochondroma have been documented.

CASE PRESENTATION

We report a rare case of a 25-year-old patient who presented with a red and swollen leg, and the diagnosis of deep venous thrombosis (DVT) of the left popliteal vein was established. The patient also exhibited a painless, hard swelling in the popliteal fossa. Radiography revealed an exostosis on the posterior aspect of the proximal tibia. An angioscan demonstrated close relations with the popliteal vessels, leading to venous compression. The patient underwent resection through a posterior knee approach. Histopathological analysis of the exostosis ruled out malignant transformation.

CLINICAL DISCUSSION

The discussion emphasizes the need for prompt diagnostic measures when signs indicate a vascular concern in a young patient, initiating with a radiograph followed by Doppler ultrasound and/or angiography to diagnose complications and precisely delineate their relationships with the tumor. Surgical intervention is underscored as urgent, particularly in cases involving arterial thrombosis, where immediate measures such as thrombectomy or bypass with a venous graft may be necessary.

CONCLUSION

Vascular complications associated with bone exostoses are rare but require prompt surgical treatment. However, it should prompt the performance of an angioscan in the presence of any abnormalities during clinical examination or an appearance raising concerns about potential vascular conflict.

Vascular complications of tibial exostosis: A case of popliteal vein thrombosis

Tibial exostosis, also known as osteochondroma, is a common benign bone tumor found predominantly in adolescents and young adults. Vascular complications associated with this tumor, such as arterial occlusion and pseudoaneurysm formation, are rare but can lead to significant morbidity if not promptly diagnosed and managed. We present a case of a 25-year-old patient who presented with thrombosis of the left popliteal vein and a painless swelling in the popliteal fossa. Radiographic and CT angiography revealed an exostosis on the proximal tibia causing arterial occlusion and venous compression. Surgical resection of the exostosis via a posterior knee approach resulted in successful resolution of symptoms and a favorable outcome at a 12-month follow-up. Histopathological examination confirmed the benign nature of the tumor with no evidence of malignant transformation. This case highlights the importance of prompt recognition and surgical intervention in managing vascular complications associated with tibial exostosis. A multidisciplinary approach involving orthopedic and vascular specialists is crucial for achieving optimal outcomes in such cases.

Vascular Complications Caused by Tibial Osteochondroma: Focus on the Literature and Presentation of a Popliteal Artery Thrombosis with Acute Lower Limb Ischemia

Osteochondromas are common benign bone tumors, frequently found in adolescents or young adults. Most often asymptomatic and discovered by accidental findings, they may be diagnosed because of compression or dislocation. Vascular complications are an atypical presentation of osteochondromas, and include vessel perforation and thrombosis, arterial thromboembolic events and pseudoaneurysm formation. Popliteal artery thrombosis and acute lower limb ischemia caused by a tibial osteochondroma are rarely observed. Starting from a case of temporary lower extremity ischaemia caused by thrombosis of the subarticular popliteal artery due to an osteochondroma of the proximal tibial protruding in popliteal fossa, we focused a literature analysis on diagnostic and management aspects. A combined vascular-orthopedic approach was performed with intra-arterial locoregional thrombolytic therapy and then a surgical tangential resection of the tibial osteochondroma. The adequate approach for these patients includes clinical evaluation, plain radiographs, CT scan and MRI. The purpose of the present review article is to underline the importance of a combined vascular-orthopedic approach to correct diagnosis and prompt surgical management of vascular complications caused by tibial osteochondromas.