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Ann Thorac Surg 2009;88:306. doi:10.1016/j.athoracsur.2008.09.063
© 2009 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Hemothorax Caused by a Solitary Costal Exostosis

Tomoyuki Nakano, MD, Shunsuke Endo, MD*, Mitsuhiro Nokubi, MD, Hiroyoshi Tsubochi, MD

Department of General Thoracic Surgery, Jichi Medical University and Saitama Medical Center, Tochigi, Japan

* Address correspondence to Dr Endo, Department of General Thoracic Surgery, Saitama Medical Center, Jichi Medical University, 1-3311 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan (Email: tcvshun{at}jichi.ac.jp).

A 15-year-old boy presented for examination related to sudden-onset chest pain that had occurred during jogging one day earlier. He had no previous history of chest pains or a lack of breathing sounds on his right side. A laboratory analysis showed a slight elevation of C-reactive protein concentration. Chest roentgenogram and thoracentesis showed a right hemothorax. A computed tomography scan (Fig 1) showed a hemothorax near a projection from the right sixth rib.


Figure 1
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  		Fig 1.
 
An emergency right thoracoscopy under general anesthesia showed a clotted 1150-mL hemothorax. The bleeding focus was a diaphragm injury caused by the costal projection. Resection of the costal exostosis and diaphragmatic repair were successful. Pathologic study (Fig 2) showed a benign exostosis with hyaline cartilage. We diagnosed a solitary costal exostosis [1].


Figure 2
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  		Fig 2.
 


   References
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 References
 

  1. Simansky DA, Paley M, Werczberger A, Bar Ziv Y, Yellin A. Exostosis of a rib causing laceration of the diaphragm: diagnosis and management Ann Thorac Surg 1997;63:856-857.[Abstract/Free Full Text]




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