Rare Presentation Of Rib Exostoses

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Thoracic computed tomography (CT) scan

Case of multiple rib exostoses manifesting as mediastinal masses in 16-year-old.

A 16-year-old female patient presented to the “Prof. George Georgescu” Cardiovascular Disease Institute, Iasi, Romania, in January 2018 with complaints of dyspnoea, moderate exertion and fatigue. A month ago, the patient’s paediatrician diagnosed her with multiple rib exostoses manifesting as mediastinal masses.

The patient’s medical history revealed a family history of exostosis. Clinical examination showed a chest deformation of carinatum type. Pectus carinatum, also known as pigeon or keel chest, is a rare chest deformity. It causes the breastbone to push outward.

Lab results did not signify any inflammatory syndrome. Hemoleucogram, hepatorenal function and blood glucose level were normal. Echocardiography revealed a normal functioning heart with normal heart cavities. Similarly, chest radiograph was remarkable of bony lesions and a retrosternal mass in the lateral view. In addition to opacities of chalky intensity on the left side of the thoracic wall at the level of the 2nd, 3rd and 4th left costosternal joints.

Thoracic computed tomography (CT) scan showed an expansive heterogenous mediastinal mass. The mass was at the level of the left 2nd and 3rd costosternal joints. An exostoses developed toward the level of the 3rd and 4th ribs toward the pulmonary parenchyma. Similarly, hypoventilation resulted in small focal pulmonary areas with a “matt glass appearance” in the vicinity of the bone masses.

Histopathological exam was remarkable of osteocartilaginous exostoses and mature cortical bone covered by fibrous tissue. Areas of spongy bone and bone marrow spaces were also present. However, there were no signs of malignant changes.

Treatment included removal of the masses and costosternal joints. The patient had an uneventful recovery and showed improvement in symptoms of dyspnea and fatigue.

References

Rib Exostoses Presenting as Mediastinal Masses: A Rare Presentation and Minireview of the Literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021453/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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