HEREDITARY MULTIPLE EXOSTOSES PRESENTING WITH CHEST PAIN IN ADOLESCENT MALE

TOPIC: Pediatrics TYPE: Fellow Case Reports INTRODUCTION: Hereditary multiple exostoses (HME) is a syndrome characterized by presence of two or more osteochondromas (exostoses) in the appendicular axial skeleton. Here, we present case an adolescent patient presenting with chest pain as only symptom intrathoracic exostosis leading to diagnosis HME. CASE PRESENTATION: A previously healthy 15-year-old male presented pediatric pulmonary clinic for months-long history recurrent left-sided pain, without any associated symptoms. Chest x-ray showed ill-defined nodular opacity left upper lobe, central calcification identified. Additional work-up spirometry, complete blood count, fungal antibody panel, and Histoplasma urine antigen testing was normal. Family positive embolism "blood clotting issues" no specific syndromes computed tomography angiography (CTA) contrast ordered further evaluation.Chest CTA revealed large bony arising from anterior aspect third rib, areas surrounding soft tissue measuring 3 cm x 1.3 2.6 cm. There extension into lung abutting pleura lateral mediastinum. protuberances were noted along fifth right second bilateral scapulae. HME made because exostoses. Due continued he referred cardiothoracic surgery. The decision monitor symptoms obtain repeat imaging six months growth worsening impingement. DISCUSSION: most common location Though rare, involvement ribs can occur [1]. Previous reports have identified costal patients known [1,2]. here represents complaint prior being made. should be considered adolescents if other causes are ruled out. supports Cases complications, including hemothorax, pneumothorax, pericardial effusion [3]. Supportive care observation usual plan care. However, complications develop, surgical resection may necessary surgery consultation recommended. CONCLUSIONS: REFERENCE #1: Mazza D, Fabbri M, Calderaro C, Iorio Labianca L, Poggi Turturro F, Montanaro A, Ferretti A. caused ribs: report review literature. World J Orthop. 2017 May 18;8(5):436-440 #2: Khosla Parry RL. Costal osteochondroma causing pneumothorax adolescent: Pediatr Surg. 2010 Nov;45(11):2250-3. #3: Yan G, Littlewood Latimer MD. Unusual cause pleuritic child. BMJ Rep. 2016 Nov 28;2016:bcr2016217307. DISCLOSURES: No relevant relationships Brooke Gustafson, source=Web Response Lisa Ulrich,