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| Year : 2009 | Volume
: 55
| Issue : 4 | Page : 275 |
Recurrent chest pain: Anusual cause
DS Neogi1, A Jaiman1, CS Yadav2, HL Nag2
1 Department of Casualty, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India
2 Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India
| Date of Web Publication | 14-Jan-2010 |
Correspondence Address:
D S Neogi
Department of Casualty, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0022-3859.58933
How to cite this article:
Neogi D S, Jaiman A, Yadav C S, Nag H L. Recurrent chest pain: Anusual cause. J Postgrad Med 2009;55:275 |
A 25-year-old male presented with history of recurrent right-sided chest pain and breathlessness on exertion for over a month. There was no history of cough, malaise or fever. On examination, there was slight fullness in the second inter-costal space. The second rib appeared thickened. Chest radiography [Figure 1] revealed a bony lesion from second rib. Computed tomography [Figure 2] showed a mass continuous with the second rib and growing inwards. A provisional diagnosis of osteochondroma was made. Patient had no other lesion in the body. The mass was resected along with a small portion of the second rib (4 x 3.5 cm). Histopathological examination confirmed the lesion to be an osteochondroma. On follow-up at six months, the patient's complaints had completely resolved.
Primary tumors of the thoracic cage constitute of 5-8% of primary bone tumors and osteochondroma of the ribs is exceedingly rare. [1] Osteochondromas are a developmental physical growth defects. Osteochondromas are cartilage capped outgrowths of bone wherein the growth stops at skeletal maturity. [1] Two broad types of rib exostosis are usually encountered: Hereditary multiple exostosis (HME), an autosomal dominant condition characterized by multiple exostosis, usually seen in the long bones and solitary costal exostosis (SCE). These are rarely seen in the ribs [1] and when they project outside, they may be felt as swellings on the chest while those projecting inward are generally symptomless and constitute an incidental finding on chest radiographs. Sometimes these take on large sizes and present with complications like acute chest pain and are followed by complications like hemothorax, hemopneumothorax, pericardial effusion, pleural effusion, diaphragmatic rupture. [2],[3],[4],[5] Although an SCE is difficult to diagnose preoperatively, a costal exostosis in HME appears to be much easier to detect because of the significant familial history and frequent association with characteristic limb deformities. [3] The recurrent chest pain during exertion in our patient may have been caused by shearing of the adjacent lung and pleura, as the lung capacity increases during activity. The high location on the second rib may also have caused compression of the bronchi secondary to pressure effect during increased requirements of activity. Exostosis penetrating an intrathoracic structure could be a life-threatening situation and hence it needs to be resected.
| :: References | |  |
| 1. | Harrison NK, Wilkinson J, O'Donohue J, Hansell D, Sheppard MN, Goldstraw PG, et al. Osteochondroma of the rib: An unusual cause of haemothorax. Thorax 1994;49:618-9.  [PUBMED] [FULLTEXT] |
| 2. | Bini A, Grazia M, Stella F, Petrella F. Acute massive haemopneumothorax due to solitary costal exostosis. Interact Cardiovasc Thorac Surg 2003;2:614-5 [PUBMED] [FULLTEXT] |
| 3. | Fukai I, Fujii Y, Hisada M, Mashita K, Suzuki I. Pericardial hemorrhage caused by costal exostosis. Ann Thorac Surg 2002;74:2171-2. [PUBMED] [FULLTEXT] |
| 4. | Abdullah F, Kanard R, Femino D, Ford H, Stein J. Osteochondroma causing diaphragmatic rupture and bowel obstruction in a 14-year-old boy. Pediatr Surg Int 2006;22:401-3. [PUBMED] [FULLTEXT] |
| 5. | Graham J, Winterson R, Grovell J, Boon RL. An unusual cause of a pleural effusion. Emerg Med J 2008;25:749. [PUBMED] [FULLTEXT] |
[Figure 1], [Figure 2]
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