Thrombosed Popliteal Artery Pseudoaneurysm as Herald of Tibial Osteochondroma

Abstract

BackgroundOsteochondroma is the most common non-malignant tumour of bone, accounting for approximately one third of benign lesions in the skeleton. They often develop around the knee in the distal femur and in the proximal tibia and fibula. They present as a painless slow growing mass during adolescence and have been reported to cause damage to adjacent structures such as blood vessels; arterial damage is more common than venous injury and is usually a result of compression, stretching, and rubbing of the arterial wall. Such lesions include stenosis, thrombosis, and pseudoaneurysm formation possibly causing lower limb claudication or acute limb ischemia.MethodsAn 18 year old male patient with a 4 week history of pain, hematoma, and oedema of the left calf without previous trauma is reported. A computed tomography scan (CT) revealed a large popliteal artery pseudoaneurysm and its close relationship to a protrusion of the proximal tibia.ResultsThe popliteal artery was repaired by an external saphenous patch and the exostosis was removed. The patient had palpable popliteal and distal pulses after surgery and during the first year follow-up.ConclusionsTibial osteochondroma should be considered in the differential diagnosis in young patients, among the potential causes of pseudoaneurysm of the femoral or popliteal artery. Surgical repair should be performed to restore normal blood flow with resection of the exostosis to prevent recurrence.

Case Series – Osteochondromas at Rare Locations

“…However, discomfort, palpable masses, and pathological fractures, which appear in roughly 17–94% of patients, are the most prevalent symptoms and signs [ 11 ]. While compressive neuropathy, bursa development with subsequent bursitis and limb deformity is also mentioned in the literature [ 8 , 9 ].…”

“…Osteochondromas may present as a lone tumor also known as osteocartilaginous exostosis or as group of multiple tumors also known as multiple osteochondromatosis, Osteochondromas may sometimes turn into malignant lesions [ 6 , 7 ]. Most of these exostoses remain asymptomatic and undetected until they grow and achieve adequate size to cause compression of neurovascular bundles or vital organs in their vicinity [ 8 , 9 ].…”

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

“…Arterial damage is represented in 91% of vascular complications, 2 including pseudoaneurysms and aneurysms, intermittent compression, thrombosis and stenosis while venous damage is presented with venous thrombosis or compression. 2–4 Pseudoaneurysms are rare and mainly occur after the end of enchondral ossification phase, when the cartilage cap becomes firm and rigid. 2 The mean age at which vascular complications usually occur is 22.6 years, 2 in contrast to our patient, who was 67 years of age.…”