Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2017; 8(5): 436-440
Published online May 18, 2017. doi: 10.5312/wjo.v8.i5.436
Chest pain caused by multiple exostoses of the ribs: A case report and a review of literature
Daniele Mazza, Mattia Fabbri, Cosma Calderaro, Carlo Iorio, Luca Labianca, Camilla Poggi, Francesco Turturro, Antonello Montanaro, Andrea Ferretti
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
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report was approved by the Institution review board.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Daniele Mazza, MD, Orthopedic Division, Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy. daniele.mazza@hotmail.it
Telephone: +39-06-33775818 Fax: +39-06-33775918
Received: October 10, 2016
Peer-review started: October 11, 2016
First decision: November 14, 2016
Revised: February 7, 2017
Accepted: February 28, 2017
Article in press: March 2, 2017
Published online: May 18, 2017
Processing time: 214 Days and 12.9 Hours
Abstract

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.

Keywords: Multiple hereditary exostoses; Thoracoscopy; Ribs exostoses; Chest exostoses; Chest pain

Core tip: This is a report of an exceptional case of multiple internal exostoses of the ribs in a young patient affected by multiple hereditary exostoses observed for chest pain as symptom of an intra-thoracic localization. Chest pain could be the only symptom of an intra-thoracic localization, possibly leading to serious complications. Thoracic localization must be suspected when patients complain chest pain. Computed tomography scan in indicated to confirm exostoses and to clarify relationship with surrounding structures. Video-assisted thoracoscopy 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.