Huge Bursitis and Bursal Synovial Osteochondromatosis Associated With Scapular Osteochondroma Mimicking a Giant Calcific Mass of the Chest Wall

Abstract

Osteochondroma is the most common benign bone tumor but it rarely arises from the scapula. Scapulothoracic bursitis is quite rare and osteochondroma is one of the unusual causes of this condition. Synovial chondromatosis may occur extremely uncommonly in this bursa. We reported an unusual case of scapulothoracic bursitis with synovial chondromatosis which is caused by osteochondroma. To the best of our knowledge, there is no defined chondromatosis in the scapulothoracic bursa secondary to scapular osteochondroma in the literature.An osteochondroma originating from the inner surface of the scapula can irritate this bursa and scapulothoracic bursitis may develop. Clinical manifestations are usually pain and swelling on the posterior chest wall. Patients may also declare crepitation by shoulder rotation. Ultrasonography can reveal a fluid collection between the serratus anterior muscle and chest wall. On computed tomography (CT) a hypodense, well-demarcated cystic mass may be seen at this location. Its magnetic resonance (MR) imaging features are similar to other cystic lesions. It is hypointense on T1-weighted images and hyperintense on T2-weighted images. Synovial chondromatosis or osteochondromatosis is a benign synovial metaplastic proliferation that occurs extremely uncommonly in bursae. When we searched 'large scapulothoracic bursa chondromatosis' phrases in lliterature review of Chochran Database and Web of Science, we could not find any case reports of synovial chondromatosis in large scapulothoracic bursa. The bursal chondroid bodies appear hypointense on T1-weighted images and hyperintense on T2-weighted images but the signal intensity decreases in all sequences as the calcific or ossific component of these nodules increases. We here report an unusual case of scapulothoracic bursitis with synovial osteochondromatosis which is caused by osteochondroma. A written informed consent was taken from the patient.

Synovial Chondromatosis of the Hip Joint: A Case Report

“…25 In symptomatic patients, surgical excision of loose bodies is the preferred method of treatment, which includes open or arthroscopic loose body removal and synovectomy. 26,27 Early open or arthroscopic debridement, synovectomy, and loose body removal before articular cartilage damage showed good results, 28,29 but open debridement and loose body removal require hip dislocation, which may increase the risk of femoral head avascular necrosis in the future. The arthroscopic procedure is associated with a high rate of recurrence and incomplete debridement.…”

“…The arthroscopic procedure is associated with a high rate of recurrence and incomplete debridement. 26,27 The surgical intervention in different articles varied, so we planned for an arthroscopy-assisted mini-open approach. 26,27 We could not remove all loose bodies arthroscopically so we had to make a mini anterior incision and performed a synovectomy and remove all loose bodies.…”

Synovial Chondromatosis of Hip in a Young Patient Salvaged With Mini Arthrotomy Without Hip Dislocation – A Case Report

“…The gold standard for diagnosis is histopathological examination. Surgical excision of loose bodies is the treatment of choice in symptomatic patients, which includes loose body removal by open or arthroscopic approach and synovectomy [ 1 , 2 ]. Early open or arthroscopic debridement, synovectomy, and loose body removal before the damage of the articular cartilage showed good results in the literature [ 17 , 18 ], but open debridement and loose body removal require dislocation of hip, which may pose the risk of avascular necrosis of femoral head in future.…”

“…Synovial chondromatosis is a rare, benign disorder of the synovium, which leads to loose body formation due to metaplastic transformation. It presents as multiple cartilaginous bodies in the synovial joints, bursae, and in tendon sheaths [ 1 , 2 , 3 ]. The knee joint is the most common to involve which accounts about 50–65% of the cases followed by hip, elbow, shoulder, and ankle joints.…”

Imaging Features of Soft Tissue Tumor Mimickers: A Pictorial Essay

“…They often occur in the foot and ankle but can also occur with exophytic bone tumors such as an osteochondroma. 29 A pitfall is to not overlook the underlying cause of the adventitial bursa.…”