Pleural effusion is a relatively common condition encountered in the pediatric emergency department. Evaluation of pleural effusion in the emergency department typically includes advanced imaging such as computer tomography or ultrasound, as well as diagnostic thoracocentesis. We report a case of a 10-year-old female with a rib spur at the anterolateral left sixth rib that caused a hemothorax, pneumothorax, and diaphragmatic injury. The patient underwent video-assisted thoracoscopic surgery and resection of the rib spur. The procedure was well-tolerated without any complications.

Osteochondromas, also known as exostoses, are the most common benign tumors of bone and can be classified into isolated and multiple osteochondromas. A great majority of osteochondromas is asymptomatic, painless, slow-growing mass, and incidentally found. However, osteochondromas occurring in adolescence or in adult patients can grow in size and become symptomatic as a result of mechanical irritation of the surrounding soft tissues or peripheral nerves, spinal cord compression, or vascular injury.

We present a case of a 13-year-old girl with spontaneous hemothorax, the cause of which was identified by limited thoracotomy with the aid of video-assisted thoracic surgery to be bleeding from a diaphragmatic laceration incurred by a costal exostosis on the left sixth rib. Preoperative chest computed tomography (CT) depicted a bony projection arising from the rib and bloody effusion in the intrathoracic cavity, but was unable to discern the bleeding cause from the lung or the diaphragm. This case will highlight our awareness that costal exostosis possibly results in bloody pleural effusion. Meanwhile, English literatures about solitary costal exostosis associated with hemothorax were searched in PubMed and nineteen case reports were obtained. Combined our present case with available literature, a comprehensive understanding of this rare disease entity will further be strengthened.

Injury to the diaphragm is the primary cause of hemothorax caused by costal osteochondroma, including the present case. Thoracic CT scan can help establish a diagnosis of preoperative diagnosis of costal osteochondroma. Surgical intervention should be considered for those patients with symptomatic osteochondroma of the rib. Combined with our case and literature, prophylactic surgical removal of intrathoracic exostosis should be advocated even in asymptomatic patients with the presentation of an inward bony spiculation.

• CT
• Costal osteochondroma
• Hemothorax
• Treatment

We applied computed tomography (CT) to explore the imaging manifestations of rare parts of osteochondroma. Based on the medical images, deblurring using a convolutional neural network (CNN), and three-dimensional (3D) reconstruction of the images is performed in order to improve the image diagnosis.

Twelve cases of osteochondroma in rare locations confirmed by surgical pathology or clinical long-term dynamic observation were retrospectively analyzed using medical imaging and image reconstruction. There are 7 males and 5 females, with an average age of 43 years. CT examinations were performed in all cases. Image deblurring via the GAN model is performed followed by the 3D reconstruction of the higher quality images is implemented. A retrospective study was performed on the imaging manifestations of the above cases; the imaging characteristics were summarized.

The imaging features are the following lesions, including 4 cases of the proximal radius, 4 cases of the scapula, 2 cases of the pelvis, and 2 cases of the proximal ribs. The cartilage caps, cortex, and sternum were typical structures of the bone surface of the studied cases. In the continuous imaging features, calcification was visible in some cases, and no significant enhancement was seen in enhanced scans; there was no obvious direction of lesion growth. The image processing techniques that we performed are useful in enhancing the quality of the medical diagnosis.

Rare site osteochondroma has certain imaging features. In most cases, we can accurately diagnose rare site osteochondroma through these features via the image processing methods that are proposed in this paper.

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 follow-up, 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.

• Multiple hereditary exostoses
• Thoracoscopy
• Ribs exostoses
• Chest exostoses
• Chest pain

• diaphragmatic injury
• osteochondroma
• spontaneous hemothorax
• vertebral exostosis

Osteochondromas (exostosis) are the most common neoplasm of bone and arise from the metaphysis of bones. Tumors of the chest wall comprise approximately 2% of all tumors of the body and may be primary or metastatic, benign or malignant. Osteochondroma is a common bone tumor but a rare tumor in the rib. It is often asymptomatic and observed incidentally. The tumors typically begin to grow before puberty and continue until bone maturation is reached. Surgery is required in childhood if these lesions are painful or disfiguring, while those arising in adulthood should always be resected.

9 yr old boy presented to OPD with swelling over right chest. Radiograph showed bony outgrowth on the lateral aspect of the 6th rib. The patient was kept under closed observation and was treated conservatively. Three years follow-up didn’t show any increase in the size of the swelling and the patient did not have any complaints.

Though various studies have shown that the surgical resection of osteochondroma is necessary to avoid further complications of Haemothorax, pneumothorax or intercostal neuralgia, we concluded that osteochondroma of the ribs can even be conserved if not associated with complications and patient does not need to undergo unnecessary surgery.

• Exostosis
• Rib
• Tangential view

Costal exostosis is a benign condition that sometimes requires emergent surgery because of associated hemothorax; in addition, there have been cases with malignant transformation to chondrosarcoma. Here, we describe an asymptomatic patient who underwent thoracoscopic resection for primary costal exostosis.

A 16-year-old male was found to have a bow-shaped shadow on a chest X-ray. Chest computed tomography revealed a rod-like mass with a soft tissue shadow adjacent to the left fifth rib. A thoracoscopic partial resection of the left fifth rib was performed. Intraoperative findings included thickening of the pericardium near the tip of the growth and erosion of the visceral pleura of the left lung. The resected specimen was diagnosed as a primary costal exostosis based on histopathological findings.

We review the published literature on costal exostosis and discuss the surgical indications of asymptomatic cases.

• Coil embolization
• Costal
• Hemothorax
• Osteochondroma
• Rib

• Acute Coronary Syndrome/diagnosis
• Acute Coronary Syndrome/etiology
• Acute Coronary Syndrome/physiopathology
• Adolescent
• Coronary Angiography
• Coronary Vessels/diagnostic imaging
• Delivery, Obstetric/adverse effects
• Exostoses/diagnosis
• Exostoses/etiology
• Exostoses/pathology
• Exostoses, Multiple Hereditary/complications
• Female
• Humans
• Magnetic Resonance Imaging, Cine
• Multimodal Imaging/methods
• Pregnancy
• Pregnancy Complications, Cardiovascular/diagnosis
• Pregnancy Complications, Cardiovascular/etiology
• Pregnancy Complications, Cardiovascular/physiopathology
• Pressure/adverse effects
• Pulmonary Artery/diagnostic imaging
• Ribs/abnormalities
• Ribs/diagnostic imaging
• Ribs/surgery
• Thoracic Surgery, Video-Assisted/methods
• Tomography, X-Ray Computed/methods
• Treatment Outcome

• Diagnostics
• Etiology
• Post-mortem evaluation
• Spontaneous hemothorax
• Sudden death

• Adolescent
• Bone Neoplasms/complications
• Bone Neoplasms/surgery
• Female
• Hemothorax/etiology
• Humans
• Osteochondroma/complications
• Osteochondroma/surgery
• Pleura/pathology
• Ribs/pathology
• Rupture

• Child
• Exostoses, Multiple Hereditary/complications
• Exostoses, Multiple Hereditary/surgery
• Female
• Hemothorax/etiology
• Humans
• Pericardial Effusion/etiology
• Ribs/pathology
• Ribs/surgery
• Treatment Outcome

• Bone Neoplasms/diagnosis
• Child
• Diaphragm/pathology
• Female
• Hemothorax/diagnosis
• Humans
• Muscular Diseases/diagnosis
• Osteochondroma/diagnosis
• Ribs/pathology
• Thoracotomy
• Tomography, X-Ray Computed

• Adult
• Bone Neoplasms/complications
• Bone Neoplasms/diagnosis
• Bone Neoplasms/diagnostic imaging
• Bone Neoplasms/surgery
• Empyema, Pleural
• Hemothorax/etiology
• Humans
• Male
• Osteochondroma/complications
• Osteochondroma/diagnosis
• Osteochondroma/diagnostic imaging
• Osteochondroma/surgery
• Ribs
• Tomography, X-Ray Computed

• Adult
• Exostoses/complications
• Hemorrhage/etiology
• Humans
• Male
• Pericardium/injuries
• Ribs