Fractured osteochondroma presenting with popliteal pseudoaneurysm: Case report and review of literature

Abstract

Osteochondroma, the most common tumor of bone, is usually asymptomatic. Vascular complications are an atypical presentation and include true or false aneurysm formation, deep venous thrombosis, and arterial insufficiency. A review of the English literature identified 130 cases of osteochondroma-related vascular complications. We describe the case of a 38-year-old man presenting with left calf pain and swelling who was diagnosed with the rare constellation of a popliteal pseudoaneurysm and incidental peroneal vein thrombosis secondary to a fractured femoral sessile osteochondroma. This was treated with resection of the osteochondroma, excision of the aneurysm, and primary end-to-end anastomosis of the artery.

Vascular Complications Caused by Tibial Osteochondroma: Focus on the Literature and Presentation of a Popliteal Artery Thrombosis with Acute Lower Limb Ischemia

“…Deep venous thrombosis in association with osteochondroma is infrequent. The osteochondroma exerts mass effect on the vein inducing thrombosis [30]. In our patient, the symptoms are related to transient acute ischemia of the lower limbs and osteochondroma was occasionally found in differential diagnosis with other vascular diseases.…”

“…Osteochondromas are the most common benign primary bone tumors in growing patients representing about 35-45% of all benign bone tumors. About 90% of these occur sporadically and are usually solitary [1,13,29,30,59]. Osteochondromas occur most often around the knee (40% of cases) and proximal tibial is affected in 15-20% of cases [59].…”

“…Osteochondromas occur most often around the knee (40% of cases) and proximal tibial is affected in 15-20% of cases [59]. Symptoms are usually related with compression of close related structure: tumors can occasionally dislocate the adjacent vessels and cause various types of vascular injury such as pseudoaneurysms, arterial thrombosis or acute lower limb ischemia [4,6,13,29,30,56,59]. However, vascular complications are an atypical presentation of osteochondromas.…”

“…The affected vessel is commonly the popliteal artery, which is involved in about 60% of the cases. Rarely, osteochondromas may be complicated by fracture secondary to strenuous physical exercise or trauma, resulting in sharp bone spicules that pierce the artery, causing pseudoaneurysm formation [30]. Sakata et al reported a pseudoaneurysm of the popliteal artery in a 16-year-old boy that underwent emergency surgery.…”

“…Vascular complications were due to osteochondromas of the femur (66.2%), tibia (15.4%), fibula (7.7%), humerus (5.4%), clavicle (1.5%), ribs (1.5%), pubic ramus (0.8%), scapula (0.8%) and cervical vertebra (0.8%). The popliteal artery was involved in 66% of cases, and popliteal pseudoaneurysms were the most prevalent vascular complication (49%) [30]. In the same paper the case of a 38-year-old man was reported, presenting with left calf pain and swelling due to a popliteal pseudoaneurysm and incidental peroneal vein thrombosis secondary to a fractured femoral sessile osteochondroma, treated with resection of the osteochondroma, excision of the aneurysm, and primary end-to-end anastomosis of the artery [30].…”