Osteochondroma of ventral scapula associated with chest pain due to rib cage compression

Abstract

Rationale:The scapula is relatively rare site for osteochondroma. Scapula osteochondroma is usually asymptomatic, however it may present with features such as pseudowinging, snapping scapula, bursa formation, chronic pain, and cosmetic deformities. To our best knowledge, this is the first report in the English literature about osteochondroma of ventral scapula associated with chest pain due to rib cage compression.Patient concerns:A 14-year-old boy was transferred to the orthopedic clinic from thoracic surgery department with a complaint of intermittent, dull, and diffuse aching pain around left chest wall and back from the past 2 months. The patient was previously diagnosed with multiple osteochondromas on another side; proximal tibia and distal femur.Diagnosis:A radiopaque mass like lesion was observed on the scapula in the posteroanterior view of the chest, and compression of chest wall was also seen. In chest computed tomography (CT), pedunculated outgrowing bony mass was noted in the anterior aspect of the left scapular wing, which showed the continuity of bony cortex and medulla. This bony mass showed the mass effect on the left chest wall, causing left thoracic cavity deformity by making it narrower than the rightInterventions:Surgery was performed under general anesthesia. After the surgery, the arm was immobilized by putting it in an abductor pillow brace for 3 weeks, and during that period pendulum exercise was permitted.Outcomes:The patient's symptoms resolved in the immediate postoperative period. At 1 year's follow-up, the patient was symptom free and there was no evidence of recurrence of the tumor.Lessons:We recommend that in case of patients who have a history of osteochondroma and complaint of chest pain, surgeons should become suspicious of the presence of osteochondroma of the ventral scapula. In this situation, we recommend chest radiography, pulmonary function test, and chest CT for early detection and treatment.

Rare Case of Osteochondroma on the Dorsal Aspect of the Scapula

“…The incidence of osteochondroma under the age of 30 is higher in men compared to women [ 1 , 2 ]. The outgrowth is usually found on the metaphyseal region of long bones such as the tibia, humerus, and distal femur, accounting for 90% of all exostoses [ 2 , 3 ]. Flat bones, such as the scapula, account for 3-4.6% of all cases of osteochondroma, with 14.4% of scapular tumors being diagnosed as osteochondroma [ 4 , 5 ].…”

Ventral scapular osteochondroma excision through ‘triangle of auscultation’: A case series

“…The fibrous arch is relatively less vascular so even if sharp dissection is required, the surgical muscle trauma and blood loss are likely to be minimal. The subscapularis muscle arises from the medial 3/ Journal of Orthopaedic Surgery 28 (1) 5th of the ventral surface of the scapula. 4 An osteochondroma arising from the ventral aspect of scapula may breach the muscle gradually due to the dynamics of growth of the bone tumour or due to the muscle undergoing slow local attrition as it gets pinched between the osteochondroma and the rib cage.…”

“…Osteochondromas are benign tumours, most commonly distributed along the metaphysis of long bones. 1 Their occurrence in the scapular region is rare but still they are the most common primary benign bone tumours of scapula, 2 predominantly located on the ventral aspect of scapula (63%). 3 The symptoms arising from scapular osteochondromas are because of direct pressure on the overlying anatomic structures or indirectly by reactive bursitis with the former causing snapping scapula syndrome leading to restriction in range of motion.…”

Osteocondroma solitario de la escápula: localización poco habitual para un tumor frecuente

“…1,2 Tiene un ligero predominio en el sexo masculino. 1,3 La localización más común es en la metáfisis de los huesos largos, principalmente alrededor de la rodilla. En cambio, los huesos planos son localizaciones poco frecuentes para el osteocondroma, se localizan en la escápula en el 3-4,6 %.…”

“…En cambio, los huesos planos son localizaciones poco frecuentes para el osteocondroma, se localizan en la escápula en el 3-4,6 %. 1,3 Se describe el caso clínico de un paciente en edad pediátrica diagnosticado con osteocondroma en la superficie dorsal de la escápula, localización atípica para este tipo de tumor.…”