Asymptomatic costal exostosis with thickening in the pericardium: a case report

Unusual Presentation of a Rib Osteochondroma as Hard Breast Lump in a Young Male: A Case Report

Osteochondroma arising from the rib is rare. They arise as bony outgrowths from the rib and extend either extrathoracically into the subcutaneous plane or intrathoracically compressing the lung or mediastinal structures. A 23-year-old male patient presented with complaints of breast lump since last year. On clinical examination, a hard bony projection with lobulated contour was palpable. Chest radiograph and contrast-enhanced CT showed a bony outgrowth arising from the anterior aspect of costochondral junction of the right fourth rib with displacement of pectoralis major muscle anteriorly. Osteochondroma should be considered as a differential diagnosis in the presentation of hard lump in the breast along with other chest wall tumors.

Spontaneous pneumothorax in a 17-year-old male patient with multiple exostoses: A case report and review of the literature

BACKGROUND

Multiple exostoses generally develop in the first decade of life. They most frequently arise from the distal femur, proximal tibia, fibula, and proximal humerus. Costal exostoses are rare, contributing to 1%–2% of all exostoses in hereditary multiple exostoses (HME). They are usually asymptomatic, but a few cases have resulted in severe thoracic injuries. Pneumothorax caused by costal exostoses is rare, with only 13 previously reported cases. We report a new case of pneumothorax caused by costal exostoses.

CASE SUMMARY

A 17-year-old male with HME underwent surgery for removal of exostoses around his right knee. Four months following the operation, he felt chest pain when he was playing the trumpet; however, he did not stop playing for a week. He was referred to our hospital with a chief complaint of chest pain. The computed tomography (CT) scan revealed right pneumothorax and multiple exostoses in his right ribs. The CT scan also revealed visceral pleura thickness and damaged lung tissues facing the exostosis of the seventh rib. We diagnosed that exostosis of the seventh rib induced pneumothorax. Costal exostosis resection was performed by video-assisted thoracoscopic surgery (VATS) 2 wk after the onset. The patient’s postoperative course was uneventful, and there was no recurrence of pneumothorax for 2 years.

CONCLUSION

Costal exostoses causing thoracic injuries should be resected regardless of age. VATS must be considered in cases with apparently benign and relatively small exostoses or HME.

Rib osteochondroma causing cardiac compression in a pediatric patient

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Osteochondromas are considered the most common benign tumors of bony origin.

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Exostosis are slow growing masses usually diagnosed before the third decade of life.

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A computed tomography scan offers a more accurate tool in the diagnosis of this type of condition.

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Rib exostosis occurs more frequently in males than females with a ratio of 1.5:1.

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Costal osteochondromas mostly occur as a part of hereditary multiple osteochondromas.

Introduction and importance

Rib osteochondromas are rare genetic disorders, which can present as bony exostosis causing compression, impingement and damage to surrounding vessels, organs and structures within the thoracic cavity. The objective of this study was to clearly describe a rare presentation of rib osteochondromas in a pediatric patient along with managing techniques.

Case

A 9-year-old girl was admitted to the hospital due to shortness of breath on exertion. Physical examination did not reveal any abnormalities except for small bony projections over the left 5th rib. Computed tomography (CT) scan showed a bony lesion on the left fifth rib causing cardiac compression. Video-assisted thoracoscopy (VAT) was done, which showed a bony exostosis compressing the left ventricle, the lesion was resected without any complications. Final pathology confirmed the diagnosis of osteochondroma measuring 2.0 cm × 2.0 cm × 1.5 cm, along with a thickness of 0.4 cm. Post-operative recovery was well, with no morbidities and the patient was discharged without any complications. On the post-operative follow up, the patient showed significant improvement in her symptoms.

Clinical discussion

Our reported case is a rare example of a solitary costal osteochondroma leading to serious complications because of its shape, size, and location. Previous reports have not addressed any significant traumatic event or impact prior to the occurrence of symptoms related to the cases, including the case of our patient. Cases of rib exostosis were surgically approached using different techniques most often through thoracotomy.

Conclusions

Rib osteochondromas are rare benign bony lesions which can cause cardiac symptoms secondary to direct compression. They can be resected safely via video assisted thoracoscopy (VAT) or limited thoracotomy.

Non-traumatic complications of a solitary rib osteochondroma; an unusual cause of hemoptysis and pneumothorax

Osteochondromas are a very common and usually asymptomatic entity which may originate anywhere in the appendicular and axial skeleton. However, the ribs are a rare site of origin and here they may prove symptomatic for mechanical reasons. In this case report, we describe an unusual case of a symptomatic osteochondroma of the rib secondary to its location and unique shape, ultimately requiring surgical intervention.