Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China.
Pediatric Surgery, the First Hospital of Jilin University, Changchun, 130021, China.
J Cardiothorac Surg. 2022 Sep 6;17(1):230. doi: 10.1186/s13019-022-01984-7.
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.
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.
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.
骨软骨瘤，也称为外生骨疣，是最常见的良性骨肿瘤，可分为孤立性和多发性骨软骨瘤。绝大多数骨软骨瘤是无症状、无痛、生长缓慢的肿块，通常是偶然发现的。然而，在青少年或成年患者中发生的骨软骨瘤可能会增大，并由于周围软组织或周围神经、脊髓受压或血管损伤而引起症状。
我们报告了一例 13 岁女孩自发性血胸的病例，通过辅助胸腔镜手术的有限开胸术确定了病因，即左第六肋的肋软骨瘤引起的膈肌撕裂导致出血。术前胸部 CT 显示肋骨上有一个骨性突起和胸腔内血性渗液，但无法从肺部或膈肌上明确出血原因。本例将提醒我们注意到肋软骨瘤可能导致血性胸腔积液。同时，在 PubMed 上搜索了关于孤立性肋软骨瘤合并血胸的英文文献，共获得 19 篇病例报告。结合我们的病例和现有文献，对这种罕见疾病实体的全面认识将进一步加强。
肋软骨瘤导致血胸的主要原因是膈肌损伤，包括本病例。胸部 CT 扫描有助于术前诊断肋软骨瘤。对于有症状的肋骨骨软骨瘤患者，应考虑手术干预。结合我们的病例和文献，即使对于表现为内向性骨刺的无症状患者，也应提倡预防性切除胸腔内外生骨。
