Ricerc@Sapienza

Abstract
The aim of this paper is to report an exceptional case of
multiple internal exostoses of the ribs in a young patient
affected by multiple hereditary exostoses (MHE) coming
to our observation for chest pain as the only symptom
of an intra-thoracic localization. A 16 years old patient
with familiar history of MHE came to our observation
complaining a left-sided chest pain. This pain had increased
in the last months with no correlation to a
traumatic event. The computed tomography (CT) scan
revealed the presence of three exostoses located on the
left third, fourth and sixth ribs, all protruding into the
thoracic cavity, directly in contact with visceral pleura.
Moreover, the apex of the one located on the sixth rib
revealed to be only 12 mm away from pericardium. Patient
underwent video-assisted thoracoscopy with an additional
4-cm mini toracotomy approach. At the last 1-year followup,
patient was very satisfied and no signs of recurrence or
major complication had occured. In conclusion, chest pain
could be the only symptom of an intra-thoracic exostoses
localization, possibly leading to serious complications.
Thoracic localization in MHE must be suspected when
patients complain chest pain. A chest CT scan is indicated
to confirm exostoses and to clarify relationship with surrounding
structures. Video-assisted thoracoscopic surgery
can be considered a valuable option for exostoses removal,
alone or in addiction to a mini-thoracotomy approach, in
order to reduce thoracotomy morbidity.