Paediatric vascular-related hereditary giant rib osteochondroma: report of a successful chest wall reconstruction

Hereditary multiple osteochondromas (HMO) are benign neoplasms that predominantly affect the bones around the knee joint, proximal humerus, wrist, pelvis, and to a lesser extent, the rib. Although rib-origin osteochondromas are uncommon and often asymptomatic, they can lead to pleural, pericardial, and diaphragmatic injuries secondary to tumour related pressure. We are presenting a unique case of a vascular-related giant osteochondroma rib that is hereditary, originating from the right second, third, and fourth ribs causing compression symptoms in a young child. The child underwent wide local excision and reconstruction using polypropylene mesh that was managed successfully with no recurrence.

A 9-year-old male experiencing fullness and pain in the right chest for two months with a parallel medical history of swellings in first- and second-generation relatives that is hereditary in origin underwent contrast-enhanced computed tomography revealing a sessile rib osteochondroma arising from the anterior aspects of the right second to fourth ribs with an associated large cartilaginous cap. The bony growth measured 4.5 × 2.5 cm indenting the right upper lobe while, its cartilaginous cap measured 2.5 × 4.8 cm posterior-superiorly seen encasing the axillary artery and 3D volumetric reconstructive image revealed the proximity of the axillary and subclavian artery with the lesion. A biopsy was inconclusive with no malignant cells, so he underwent wide local excision of the tumour and reconstruction with polypropylene mesh. Follow-ups at one, three, six, and nine months were uneventful with normal thoracic curvature and no sign of recurrence.

This case illustrates the surgical challenges addressed and the successful outcome of a paediatric chest wall reconstruction in a growing child, utilizing advanced imaging techniques, to underscore the importance of an individualized, innovative approach in managing rare skeletal anomalies.