Symptomatic fibrous dysplasia of the right first rib excised via a posterolateral thoracotomy.

A 35 year old housewife presented to her general practitioner complaining of discomfort in her right supraclavicular fossa for some weeks past. No abnormality was found on examination at this time, but a chest radiograph (fig 1) showed a 3.5cm calcified expansion of the anterior end of the first rib. Radiologically this was considered to be a chondroma, although malignancy could not be excluded. On examination at this time a smooth mass could be palpated just posteriorly to the clavicle. There was no evidence of a neurovascular lesion and no regional lymphadenopathy. A mass radiograph taken five years previously showed no evidence of this lesion. In view of the recent history of pain, excision was deemed necessary to confirm the pathological nature of the mass. The anterior three quarters of the first rib, including the tumour, was excised through a posterolateral approach after division of the second rib (fig 2). Postoperative recovery was rapid and uneventful. Histological examination showed the lesion to be fibrous dysplasia. The cosmetic result was good and the patient remains well.