Complicação vascular de osteocondroma: relato de caso

Abstract

Osteocondromas ou exostoses são os tumores benignos mais comuns do tecido ósseo. Eles surgem durante o período de crescimento e, raramente, são responsáveis por complicações vasculares. No presente relato, reportamos um caso de paciente com osteocondroma no membro inferior e complicação vascular provocada pela compressão da artéria poplítea. O paciente apresentava queixas de dor em membro inferior direito quando foi investigado com angiografia e radiografia, que identificaram a lesão vascular e a tumoração óssea. Os tratamentos cirúrgicos simultâneos de ambas as lesões foram realizados com boa evolução pós-operatória.

Chronic venous disease as a clinical manifestation of tibial osteochondroma

“…In around 90% of cases they are single lesions. The appearance of multiple lesions is linked with an autosomal dominant pattern of heredity and it has been recently demonstrated that the EXT1, EXT2 and EXT3 genes are involved in its etiology [1][2][3][4][5] . Osteochondromas are composed of hyperplastic bone tissue provoked by abnormal development of subperiosteal epiphyseal cartilage, which gives the lesion a "protective cap".…”

“…The tibia, fibula and humerus are the next most commonly observed sites, in decreasing order of frequency 2 . Osteochondroma rarely present with vascular complications and arterial lesions are more common of those that do have vascular involvement, accounting for 91%, with pseudoaneurysm the most often described of these, in 64% of cases 3,6 . The popliteal artery is most often affected because of the increased incidence of these lesions on the distal femur and proximal tibia and because of the artery's intimate relationship with the bone structure, since the artery is fixed proximally at the adductor canal by musculofascial compression and distally by its collateral branchings [1][2][3][4]6,7 .…”

“…Osteochondroma rarely present with vascular complications and arterial lesions are more common of those that do have vascular involvement, accounting for 91%, with pseudoaneurysm the most often described of these, in 64% of cases 3,6 . The popliteal artery is most often affected because of the increased incidence of these lesions on the distal femur and proximal tibia and because of the artery's intimate relationship with the bone structure, since the artery is fixed proximally at the adductor canal by musculofascial compression and distally by its collateral branchings [1][2][3][4]6,7 . Exostosis compromises the deep venous system by obstructing blood flow in around of 5% of complications 3. The popliteal fossa is lozenge-shaped and is delimited above and medially by the semimembranosus muscle, superolaterally by the biceps femoralis muscle, inferomedially by the medial head of the gastrocnemius muscle and inferolaterally by the plantar muscle and the lateral head of the gastrocnemius muscle.…”

“…Osteochondroma is diagnosed by simple X-ray which will show anomalous bony structures and can also detect fractured exostoses [1][2][3][4][5][6][7] . In our view, a duplex flow study of the popliteal vessels is mandatory.…”

“…Vascular involvement caused by osteochondroma is observed rarely, occurring most often in young patients at ages compatible with the end of the skeleton's growth period when the epiphyses of bones are closing [1][2][3] . In this paper we describe the case of a diabetic patient who had been admitted to hospital for an infected lesion of the left foot requiring surgery and parenteral antibiotic therapy.…”