Unusual osteochondroma of the medial part of the clavicle causing subclavian vein thrombosis and brachial plexopathy. A case report

Arthroscopic Resection of Distal Clavicular Osteochondroma: A Case Report

CASE

A 23-year-old boy presented with a 3-month history of right shoulder pain. Radiographs and computed tomography showed an exostosis on the inferior aspect of the distal clavicle. It was osteotomized and removed by arthroscopy. The histological examination confirmed the diagnosis of osteochondroma. The patient was found asymptomatic with full range of motion in the last clinical control at 1 year of follow-up.

CONCLUSION

This case report shows an arthroscopic resection of distal clavicular osteochondroma achieving complete resection of the tumor with an excellent clinical outcome. The technique offers a direct view of the inferior aspect of the clavicle and preserves the acromioclavicular joint.

Horner Syndrome Secondary to Osteochondroma of the First Rib: A Case Report

Osteochondroma is the most common benign tumor of bone that often produces no symptoms unless the enlarged mass affects nearby structures. Rarely, Horner syndrome can be caused by an osteochondroma. A five-year-old female with a past medical history of seizure-like activity presented to the emergency department on three separate occasions within one month. She exhibited neurological deficits, including miosis and ptosis, resulting in the diagnosis of Horner syndrome. Computerized tomography (CT) demonstrated a calcified and ossified lesion arising from the right first rib and transverse process that was suspicious for an osteochondroma or chondrosarcoma with neuroblastoma lower on the differential diagnosis. Given the patient's escalating clinical symptomatology and suspicious features of the lesion, a CT guided-bone biopsy was performed. Pathology revealed an osteochondroma that was eventually resected by neurologic and orthopedic surgeries. In this case report, we review the sympathetic innervation to the head, eye, and neck, the most common etiologies of Horner syndrome, and elucidate imaging modalities useful for diagnosing osteochondroma. Horner syndrome secondary to osteochondroma of the first rib has been documented only once before.

Arthroscopic treatment of an unusual distal clavicle ostheochondroma causing rotator cuff impingement: case report and literature review

Chronic shoulder impingement is one of the most common causes of shoulder pain. Intrinsic, extrinsic and secondary factors play a role in this syndrome; however the etiology of the pathology is still under debate. In rare cases, it can be caused by tumors, such as an osteochondroma. In the present study, a 49-year-old patient presented with shoulder pain for 6 months. Initially he underwent conservative treatment, without relief of symptoms. Xrays and MRI were then performed and showed the presence of an exostotic formation on the undersurface of the lateral third of the clavicle. The formation was arthroscopically removed. Histologic examination confirmed the diagnosis of osteochondroma. After surgery, the patient resumed fully activities with no symptoms within 3 months. At 1 year follow up, there are still no clinical or radiological signs of recurrence. This is, to our knowledge, the first case where an arthroscopic approach was used to remove an ostochondroma of the distal third of the clavicle.

Distal Clavicle Osteochondroma Causing Supraspinatus Tendinopathy

Shoulder pain is a very common symptom especially in young and active population. Rotator cuff tendinopathies are believed to be the most common cause of shoulder pain up to 86%. Tumors around the shoulder area can cause pain or joint stiffness when expanding in the subacromial space. We present a rare case of a distal clavicle osteochondroma. It is a benign tumor which in this area causes supraspinatus tendinopathy and every physician should suspect this kind of diseases during the diagnostic approach of a shoulder pain. In this case, early diagnosis and appropriate treatment with excision of the lesion gave us a very good outcome with fully relief of the symptoms.

Osteochondroma of the scapula associated with a subclavian artery pseudoaneurysm: Case report

Osteochondromas rarely induce vascular complications by mechanical compression. We present the case of a subclavian artery pseudoaneursym caused by an osteochondroma of the scapula in a 67-year-old male. The diagnosis was based on a previous history of multiple exostoses, computed tomography and magnetic resonance imaging, as well as the local vascular clinical status of the lesion. Surgical treatment consisted of vascular and orthopaedic intervention. First, the vascular surgeon implanted a bypass of the subclavian artery from the ventral aspect, enabling the orthopaedic surgeon to resect the osteochondroma from the dorsal aspect. The patient recovered with full function. Vascular pseundoaneurysms should be taken into consideration in patients with osteochondromas, especially with a known history of multiple hereditary exostoses.

Secondary Chondrosarcoma Presenting with Symptoms Similar to Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is caused by heterogeneous factors that compress the brachial plexus and subclavian artery; tumor is rarely a cause of TOS. Here, we present the case of a 26-year-old man with secondary chondrosarcoma arising from osteochondroma of the left clavicle causing TOS, with a direct compression of the brachial plexus and subclavian artery. Immediately after surgery, the symptoms of TOS reduced. To our knowledge, this is the first case of a secondary chondrosarcoma of the clavicle causing TOS, which is possibly the key symptom for diagnosing malignant transformation of osteochondroma of the clavicle.

Osteochondroma of the clavicle causing Horner's syndrome

A 17-year-old girl was admitted with a 1-year history of right-sided headaches and unilateral ptosis for 6 months. She was diagnosed with Horner's syndrome. Ultrasound and CT scan demonstrated an osteochondroma of the posterosuperior aspect of the medial clavicle compressing adjacent structures, including the right internal jugular vein and right common carotid artery. Cartilage sequence MRI showed an osteochondroma with a 5 mm cartilage cap. There were no suspicious features of malignancy. The patient was referred to a specialist centre for surgical resection. Osteochondroma of the clavicle presenting with Horner's syndrome is extremely rare, with only one previously reported case. In this case report, we discuss the anatomy of the oculosympathetic chain, which consists of a three neuron arc. The disruption of the neuronal arc, at any point, may result in Horner's syndrome. We also discuss the various causes of Horner's syndrome and its radiological investigation.

Gigantic clavicle osteochondroma with carotid compression as a rare cause of stroke

We report the case of a 26-year-old woman who presented with embolic stroke from left common carotid artery compression by a gigantic clavicular osteochondroma. To our knowledge, this is the only such case described in the literature. The other particularity of this case is the delayed appearance of this childhood tumor. Surgery was successful, with a satisfying outcome.