Costal osteochondroma spicule associated with pleural effusion

Abstract

Costal osteochondromas are a rare cause of lung injury. We report a 7-year-old male who presented with chest pain, cough, and left-sided pleural effusion following a fall. Imaging identified a 2 cm costal osteochondroma, which was resected with a thoracoscopic-assisted segmental rib resection.

Osteochondroma of the Rib: A Potentially Life-Threatening Benign Tumor

“…Osteochondromas are projections or exostoses on the external surface of the bone, with the presence of cortical and medullary continuity with the parent bone and a hyaline cartilage cap [ 2 , 3 ]. Typically, they originate in the metaphyseal region of long bones (distal femur, proximal tibia, and humerus), growing away from the adjacent joint [ 2 , 4 ]. In rare instances (less than 5% of cases), they occur in flat bones such as the sternum, scapula, ribs, and pelvis [ 2 ].…”

“…Costal osteochondromas are rare and more commonly occur in patients with HME [ 3 ]. They represent an infrequent cause of thoracic injury [ 2 , 4 ]. Due to the speculated morphology, they can injure the diaphragm, pleura, heart, and adjacent lung and cause life-threatening spontaneous pneumothorax and/or hemothorax [ 3 ].…”

“…Surgical resection is recommended in cases where osteochondromas emerge after puberty, become symptomatic, exhibit rapid growth, or show signs of malignant transformation [ 3 , 8 ]. Thoracoscopy is the preferred method for confirming the location of rib osteochondromas, determining their extent, and planning the surgical approach [ 4 ]. Compared to thoracotomy, thoracoscopy boasts lower complication rates, quicker recovery, reduced postoperative pain, and improved cosmetic outcomes [ 4 ].…”

“…Thoracoscopy is the preferred method for confirming the location of rib osteochondromas, determining their extent, and planning the surgical approach [ 4 ]. Compared to thoracotomy, thoracoscopy boasts lower complication rates, quicker recovery, reduced postoperative pain, and improved cosmetic outcomes [ 4 ]. Surgical techniques include segmental resection of the rib or tumor resection only [ 3 , 4 ].…”

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

“…Thoracotomy enables surgeons to cope with active bleeding from the diaphragm[ 6 ] and bowel obstruction caused by the diaphragmatic ruptures[ 17 ] or malignant tumors[ 4 ]. Extensive rib resections or relatively large tumor resections are often performed with thoracotomy only or by mini-thoracotomy using thoracoscopic-guidance[ 18 ]. Among the cases reviewed by us, five had a tumor measuring ≥ 5 cm, and four were treated by thoracotomy[ 16 , 19 - 22 ] and one with VATS[ 20 ].…”