Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2021; 12(11): 945-953
Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.945
Spontaneous pneumothorax in a 17-year-old male patient with multiple exostoses: A case report and review of the literature
Koichi Nakamura, Kunihiro Asanuma, Akira Shimamoto, Shinji Kaneda, Keisuke Yoshida, Yumi Matsuyama, Tomohito Hagi, Tomoki Nakamura, Motoshi Takao, Akihiro Sudo
Koichi Nakamura, Kunihiro Asanuma, Keisuke Yoshida, Yumi Matsuyama, Tomohito Hagi, Tomoki Nakamura, Akihiro Sudo, Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
Akira Shimamoto, Shinji Kaneda, Motoshi Takao, Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie Prefecture, Japan
Author contributions: Shimamoto A and Kaneda S were the patient’s surgeons; Nakamura K and Asanuma K wrote the manuscript; Nakamura K collected the previous reports; and All authors were involved in revising the first draft and approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient and his parent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kunihiro Asanuma, MD, PhD, Associate Professor, Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Mie Prefecture, Japan. kasanum@gmail.com
Received: June 27, 2021
Peer-review started: June 27, 2021
First decision: July 27, 2021
Revised: August 7, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: November 18, 2021
Processing time: 141 Days and 23.6 Hours
Abstract
BACKGROUND

Multiple exostoses generally develop in the first decade of life. They most frequently arise from the distal femur, proximal tibia, fibula, and proximal humerus. Costal exostoses are rare, contributing to 1%–2% of all exostoses in hereditary multiple exostoses (HME). They are usually asymptomatic, but a few cases have resulted in severe thoracic injuries. Pneumothorax caused by costal exostoses is rare, with only 13 previously reported cases. We report a new case of pneumothorax caused by costal exostoses.

CASE SUMMARY

A 17-year-old male with HME underwent surgery for removal of exostoses around his right knee. Four months following the operation, he felt chest pain when he was playing the trumpet; however, he did not stop playing for a week. He was referred to our hospital with a chief complaint of chest pain. The computed tomography (CT) scan revealed right pneumothorax and multiple exostoses in his right ribs. The CT scan also revealed visceral pleura thickness and damaged lung tissues facing the exostosis of the seventh rib. We diagnosed that exostosis of the seventh rib induced pneumothorax. Costal exostosis resection was performed by video-assisted thoracoscopic surgery (VATS) 2 wk after the onset. The patient’s postoperative course was uneventful, and there was no recurrence of pneumothorax for 2 years.

CONCLUSION

Costal exostoses causing thoracic injuries should be resected regardless of age. VATS must be considered in cases with apparently benign and relatively small exostoses or HME.

Keywords: Costal exostosis; Pneumothorax; Video-assisted thoracoscopic surgery; Hereditary multiple exostoses; Case report; Treatment

Core Tip: We report a case of pneumothorax caused by costal exostoses in a patient with hereditary multiple exostoses (HME). The computed tomography scan revealed exostoses and clarified the relationship between exostoses and the surrounding structures, which enabled us to identify the cause of the pneumothorax. Costal exostoses causing thoracic injuries should be removed regardless of age; thoracic complications are serious, and there is no apparent correlation between age at the time of operation and recurrence of thoracic complications after surgery. The application of video-assisted thoracoscopic surgery (VATS) is worthy of consideration for patients with apparently benign and relatively small exostoses or patients with HME as redo VATS may be easily offered.