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Pneumothorax caused by costal exostosis
Kentaro Imai1, Yasuhiro Suga, Yoshitaka Nagatsuka
1Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
Summary
Pneumothorax, a rare complication of rib exostosis, occurred in a teen due to friction between bone growths and pleura. This case highlights lower lobe injury as a consistent finding in such rare instances.
Area of Science:
- Orthopedics
- Thoracic Surgery
- Medical Genetics
Background:
- Hereditary multiple exostoses (HME) is a genetic disorder characterized by the development of multiple osteochondromas.
- Costal exostoses, or bone growths on the ribs, can lead to significant thoracic complications.
- Complications of costal exostosis include chest pain, hemothorax, pneumothorax, and injury to adjacent structures like the diaphragm or pericardium.
Observation:
- A 16-year-old male with a history of HME and prior rib resection presented with pneumothorax.
- The patient had exostoses on the right seventh and eighth ribs.
- The pneumothorax was attributed to chronic friction between the rib exostoses and the visceral pleura, leading to lung and pleural injury.
Findings:
- This case represents the fourth reported instance of pneumothorax secondary to costal exostosis.
- Consistent with previous reports, the pneumothorax involved injury to the lower lobe of the lung.
- The mechanism of injury involves mechanical irritation and potential laceration of the pleura by the bony outgrowths.
Implications:
- This case underscores the importance of recognizing thoracic complications in patients with HME.
- Early identification and management of costal exostoses may prevent severe respiratory compromise.
- Further investigation into the biomechanics of exostosis-pleural interaction is warranted to refine treatment strategies.
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