Cáceres’ Corner Case 253 – SOLVED

Dear Friends,

Today’s case is a PA chest radiograph for knee surgery in a 28-year-old man.

What do you see?

Click here to see the answer

Findings: PA chest radiograph shows an osteochondroma in the right humerus (A, yellow arrow). There are two more in the anterior arch of the left fifth rib and in the proximal end of the right clavicle (A, red arrows).
They are better seen in the cone down views (B-D, arrows).

The first and only diagnosis that comes to mind is multiple osteochondromatosis, confirmed with views of the lower extremities (E-G).

Final diagnosis: Multiple osteochondromatosis.
 
Most of you did very well in this case. Congratulations to Mauro, who was the first and to Kaushalya and Ali who made back-to-back diagnosis in a five-minute interval.
 
Teaching point: remember to look at the bones of the chest, especially when taking an examination. It may surprise the examiner and win you a few extra points.

15 thoughts on “Cáceres’ Corner Case 253 – SOLVED

  1. There is bulging of the right heart line at the right atrium level. This bulging is hyperlucent, with smooth contours and has obtuse angle at the mediastinum/lung border – thus, is found in mediastinum.
    Aorta looks abnormal – suggesting “figure of 3 sign”, but could not find the rib notching.
    There is also the deformation of anterior superior part of 5th rib (middle clavicle line) on the left.
    Thus: Aorta coarctation DDx pericardial cyst, but better to see first lateral chest or/and contrast inhenced fluoroscopy.

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    1. The small protuberance at the aortic knob is a nipple sign due to the left superior intercostal vein coursing around the knob.
      I believe the mild prominence of the right heart border is within normal limits.

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      1. Bravo! From a single osteochondroma of the humerus and clinical information you made a quantum leap and diagnosed hereditary multiple exostoses.
        From now on you are recommended for the Film Reading in Vienna 🙂

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  2. There is an expansile lesion of the medial head of the right clavicle.
    With a osteochondroma in the right proximal shaft of the humeus .

    Probably multiple osteochondromas-Osteochondromatosis(Diaphyseal achalsia)

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  3. Good morning!!!

    There are cartilaginous lesions in the 5 and 6 end of the left anterior costal arc and in both sterno-clavicle joints, so osteochondromatosis will be a good option

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  4. Good afternoon!

    The findings i see are:
    -Ostechondroma of proximal right humers
    -an expansile lesion of the anterior 5th left rib
    As my previous collegues, i favor osteochondromatosis.

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  5. Diaphyseal aclasis. Multiple osteochondromas – medial end right clavicle, proximal rt humerus, anterior end left 5th rib. Opacity rt apex with rim of air- ?from clav, ?postr mediastinal

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