Mazza Daniele, Fabbri Mattia, Calderaro Cosma, Iorio Carlo, Labianca Luca, Poggi Camilla, Turturro Francesco, Montanaro Antonello, Ferretti Andrea
Daniele Mazza, Mattia Fabbri, Cosma Calderaro, Carlo Iorio, Luca Labianca, Camilla Poggi, Francesco Turturro, Antonello Montanaro, Andrea Ferretti, Orthopedic Division, Sant'Andrea Hospital, La Sapienza University of Rome, 00189 Rome, Italy.
World J Orthop. 2017 May 18;8(5):436-440. doi: 10.5312/wjo.v8.i5.436.
The aim of this paper is to report an exceptional case of multiple internal exostoses of the ribs in a young patient affected by multiple hereditary exostoses (MHE) coming to our observation for chest pain as the only symptom of an intra-thoracic localization. A 16 years old patient with familiar history of MHE came to our observation complaining a left-sided chest pain. This pain had increased in the last months with no correlation to a traumatic event. The computed tomography (CT) scan revealed the presence of three exostoses located on the left third, fourth and sixth ribs, all protruding into the thoracic cavity, directly in contact with visceral pleura. Moreover, the apex of the one located on the sixth rib revealed to be only 12 mm away from pericardium. Patient underwent video-assisted thoracoscopy with an additional 4-cm mini toracotomy approach. At the last 1-year follow-up, patient was very satisfied and no signs of recurrence or major complication had occured. In conclusion, chest pain could be the only symptom of an intra-thoracic exostoses localization, possibly leading to serious complications. Thoracic localization in MHE must be suspected when patients complain chest pain. A chest CT scan is indicated to confirm exostoses and to clarify relationship with surrounding structures. Video-assisted thoracoscopic surgery can be considered a valuable option for exostoses removal, alone or in addiction to a mini-thoracotomy approach, in order to reduce thoracotomy morbidity.
本文旨在报告一例年轻患者肋骨多发性内生骨疣的特殊病例，该患者患有多发性遗传性骨疣（MHE），因胸痛前来就诊，胸痛是胸腔内病变的唯一症状。一名有MHE家族史的16岁患者因左侧胸痛前来就诊。在过去几个月里，这种疼痛有所加剧，与外伤事件无关。计算机断层扫描（CT）显示左侧第三、第四和第六肋骨上有三个骨疣，均突入胸腔，直接与脏层胸膜接触。此外，位于第六肋骨上的骨疣顶端距离心包仅12毫米。患者接受了电视辅助胸腔镜检查，并采用了额外的4厘米小切口开胸手术方法。在最后1年的随访中，患者非常满意，没有复发或重大并发症的迹象。总之，胸痛可能是胸腔内骨疣定位的唯一症状，可能导致严重并发症。当患者主诉胸痛时，必须怀疑MHE的胸腔内定位。建议进行胸部CT扫描以确认骨疣并明确其与周围结构的关系。电视辅助胸腔镜手术可被视为切除骨疣的一种有价值的选择，单独使用或与小切口开胸手术方法联合使用，以降低开胸手术的发病率。
