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/
