Thoracoscopic Resection for Costal Exostosis Presenting with Hemothorax in a Child

Introduction

Hereditary multiple exostosis (HME) is a rare disease and usually asymptomatic in most cases. Although a preoperative diagnosis on plain chest radiograph is usually difficult, in our case a chest CT scan including 3-dimensional reconstruction clearly showed that the exostosis pointed inward to the thoracic cavity. A life-threatening situation should be an indication for surgical treatment. Although several surgical treatments for costal exostosis have been reported, we successfully performed thoracoscopic resection for costal exostosis presenting with hemothorax in a 3-year-old boy.

References

• 1 Buchan K G, Zamvar V, Mandana K M, Nihal E, Kulatilake P. Juxtacardiac costal osteochondroma presenting as recurrent haemothorax.  Eur J Cardiothorac Surg. 2001;  20 208-210
• 2 Cowles R A, Rowe D H, Arkovitz M S. Hereditary multiple exostoses of the ribs: an unusual cause of hemothorax and pericardial effusion.  J Pediatr Surg. 2005;  40 1197-1200
• 3 Fukai I, Fuji Y, Hisada M, Mashita K, Suzuki I. Pericardial hemorrhage caused by costal exostosis.  Ann Thorac Surg. 2002;  74 2171-2172
• 4 Martino A, Fabrizzi G, Costarelli L, Ilari M, de Benedict F M. Haemothorax caused by isolated costal exostosis.  Eur J Pediatr Surg. 2007;  17 129-131
• 5 Pham-Duc M L, Reix P, Mure P Y, Pracros J P, Moreux N, Bellon G. Hemothorax: an unusual complication of costal exostosis.  J Pediatr Surg. 2005;  40 E55-E57
• 6 Shimansky D A, Paley M, Werczberger A, Ziv Y B, Yellin A. Exostosis of a rib causing laceration of the diaphragm: diagnosis and management.  Ann Thorac Surg. 1997;  63 856-857
• 7 Solomon L. Hereditary multiple exostosis.  J Bone Joint Surg. 1963;  45 292-304
• 8 Uchida K, Kurihara Y, Sekiguchi S, Doi Y, Matsuda K, Miyanaga M, Ikeda Y. Spontaneous haemothorax caused by costal exostosis.  Eur Respir J. 1997;  10 735-736