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Images in clinical medicine

Osteochondroma of rib

Osteochondroma of rib

Prateek Upadhyay1,&

 

1Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

 

 

&Corresponding author
Prateek Upadhyay, Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

 

 

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Osteochondroma is also known as exostosis and is a benign bone tumour. It commonly presents in the first 3 decades of life with a male preponderance. The most common site for the development of these tumours is the metaphysis of long bones, with almost 30% of cases originating from the distal metaphysis of the femur. Origin from flat bones like ilium and scapula is rare, while origin from vertebrae and ribs is unheard of. A 21-year-old female presented with a history of swelling over the left upper back since 2 years, pain in the left upper back and shoulder with tingling since 4 months. On examination, a 3 cm by 3 cm, hard, immobile mass was palpable in the left paravertebral region of the 4th Intercostal space. X-ray and CT scan of the thorax revealed two irregular lesions arising from the neck of the 5th rib posteriorly and an FNAC revealed the lesion to be of chondroid matrix origin, consisting of normal chondrocytes. Through a posterior approach, two pedunculated tumours of size 3.5 x 2 x 1cm and 2 x 2 x 1cm, along with the costovertebral junction of the 5th rib were resected. Histopathological examination confirmed the mass to be an Osteochondroma of the rib. On 6 months follow up, the patient is stable, has no pain or tingling and there is no evidence of recurrence of the tumour.

Figure 1: A) clinical picture of the swelling in the left 4th intercostal region; B) sagittal section of CT thorax showing the irregular mass between the 4th and 5th rib; C) coronal section of CT thorax showing the irregular mass between the 4th and 5th rib; D) post-operative x-ray with resected mass and the costovertebral junction of the 5th rib