Osteocartilaginous Exostosis—a Cause of Spontaneous Pneumothorax

A 14-year-old patient presented with shortness of breath and chest pain to our pediatric surgery clinic. Chest radiography showed a left pneumothorax with tension component as well as a bony abnormality at the fifth rib without corresponding finding on palpation. After tube thoracostomy, the lung expanded fully. However, the patient presented again the evening after discharge due to a pneumothorax recurrence. Instead of blebs/bullas, which are a common cause of pneumothorax, a chest computed tomography (CT) scan after insertion of a chest tube showed a hook-shaped exostosis projecting into the chest cavity and surrounding consolidation of the lung parenchyma (Figures). After thoracoscopic resection of the exostosis and pleurodesis, the chest tube could be removed on postoperative day 7. At discharge, the patient was asymptomatic. An injury to the lung opposite of the exostosis was discovered intraoperatively. Pathological examination confirmed the diagnosis of osteocartilaginous exostosis (or osteochondroma). Osteocartilaginous exostosis is the most common benign bone tumor (incidence 1:50 000). Both pneumothorax and hematothorax are rare complications of this tumor, generally requiring surgical treatment; so far only isolated cases have been described in the literature.

Figure

Posterior-anterior chest radiograph / Chest CT scan

Dr. med. Franz-Xaver Anzinger, Prof. Dr. med. Oliver Muensterer, Abteilung für Kinderchirurgie am Dr. von Haunerschen Kinderspital, München, [e-mail]

Prof. Dr. med. Julia Ley-Zaporozhan, Klinik und Poliklinik für Radiologie, Kinderradiologie, LMU München

Conflict of interest statement: The authors declare no conflict of interest.

Translated from the original German by Ralf Thoene, MD.

Cite this as: Anzinger FX, Ley-Zaporozhan J, Muensterer O: Osteocartilaginous exostosis—a cause of spontaneous pneumothorax. Dtsch Arztebl Int 2024; 121: 504. DOI: 10.3238/arztebl.m2024.0055