Hemothorax caused by costal exostosis injuring diaphragm: a case report and literature review

Background Osteochondromas, also known as exostoses, are the most common benign tumors of bone and can be classified into isolated and multiple osteochondromas. A great majority of osteochondromas is asymptomatic, painless, slow-growing mass, and incidentally found. However, osteochondromas occurrin...

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Published in:Journal of cardiothoracic surgery 2022-09, Vol.17 (1), p.1-230, Article 230
Main Authors: Pan, Ruonan, Lu, Xiaoqian, Wang, Zhijun, Duan, Lijun, Cao, Dianbo
Format: Article
Language:English
Subjects:
Adolescence
Bleeding
Bone diseases
Bone tumors
Bones
Cartilage
Case reports
Child development
Compression
Computed tomography
Costal osteochondroma
Diagnosis
Diaphragm
Diaphragm (Anatomy)
Hemoglobin
Hemothorax
Injuries
Irritation
Literature reviews
Osteochondroma
Ostomy
Pain
Patients
Peripheral nerves
Pleural effusion
Review
Rib
Ribs
Shoulder
Soft tissues
Spinal cord injuries
Teenage girls
Thorax
Treatment
Tumors
Vertebrae
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Summary:Background Osteochondromas, also known as exostoses, are the most common benign tumors of bone and can be classified into isolated and multiple osteochondromas. A great majority of osteochondromas is asymptomatic, painless, slow-growing mass, and incidentally found. However, osteochondromas occurring in adolescence or in adult patients can grow in size and become symptomatic as a result of mechanical irritation of the surrounding soft tissues or peripheral nerves, spinal cord compression, or vascular injury. Case presentation We present a case of a 13-year-old girl with spontaneous hemothorax, the cause of which was identified by limited thoracotomy with the aid of video-assisted thoracic surgery to be bleeding from a diaphragmatic laceration incurred by a costal exostosis on the left sixth rib. Preoperative chest computed tomography (CT) depicted a bony projection arising from the rib and bloody effusion in the intrathoracic cavity, but was unable to discern the bleeding cause from the lung or the diaphragm. This case will highlight our awareness that costal exostosis possibly results in bloody pleural effusion. Meanwhile, English literatures about solitary costal exostosis associated with hemothorax were searched in PubMed and nineteen case reports were obtained. Combined our present case with available literature, a comprehensive understanding of this rare disease entity will further be strengthened. Conclusions Injury to the diaphragm is the primary cause of hemothorax caused by costal osteochondroma, including the present case. Thoracic CT scan can help establish a diagnosis of preoperative diagnosis of costal osteochondroma. Surgical intervention should be considered for those patients with symptomatic osteochondroma of the rib. Combined with our case and literature, prophylactic surgical removal of intrathoracic exostosis should be advocated even in asymptomatic patients with the presentation of an inward bony spiculation. Keywords: Costal osteochondroma, Hemothorax, CT, Treatment
ISSN:1749-8090
1749-8090
DOI:10.1186/s13019-022-01984-7