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

Mimicking rib osteochondroma as pulmonary nodule in a pediatric patient: A case report from Damascus, Syria

Osteochondromas, the most frequent type of bone tumor, develop from the metaphysis region of bones. Osteochondroma often occurs in bones, however, it is rare when it comes to rib tumors. It is often asymptomatic and observed incidentally. We present a case of a 14-year-old male patient who had been experiencing cough and mild fever for approximately a week. We requested a CXR PA and LAT. It showed a pulmonary nodule measuring 1.5 cm in diameter in the upper segment of the left lower lobe. Taking into account the unclear nature of the diagnosis, we requested CT scan with contrast of the chest to obtain a better view. It showed: The nodule visualized on the CXR corresponded to a posteriorly directed, well-defined lesion arising from the costal cartilage of the third left rib, measuring 1.2 × 1.3 × 1.1 cm, likely representing an osteochondroma. The case we discussed highlights a rib osteochondroma that initially seemed like a pulmonary nodule on an X-ray, pointing out the importance of using CT scans for accurate diagnosis in such cases, and reminding us to consider osteochondroma when we see similar symptoms and to regularly check the tumor with medical imaging after it's been confirmed by a pathological test.

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.