Osteochondroma Complicated by a Popliteal Vein AneurysmA Rare Case Report

Abstract

A 21-year-old male patient presented with complaints of gradually increasing swelling in the distal aspect of his left thigh posteriorly, just above the popliteal fossa. The swelling increased over a period of 3 years. He developed acute pain with swelling over the entire leg for the past three days. Lateral and frontal radiograph of the left knee joint was performed which revealed bony outgrowth with cortical and medullary continuity, projecting from posterior surface of the lower metaphysis of left femur; suggesting a classical osteochondroma [Table/ Fig-1a&b].Doppler examination was performed which revealed dilatation of the popliteal vein, with intraluminal thrombus and extension of the thrombus into the femoral vein and the peroneal vein [Table/ Fig-2].CT angiography was performed which confirmed the osteochondroma at distal metaphysis of left femur, with cortical and medullary continuity with the parent bone. The left popliteal artery was indented by the lesion and showed an area of focal narrowing with external pressure impression. The popliteal vein showed dilatation in an eccentric saccular configuration, with filling in the delayed phase suggesting true venous aneurysm. There was internal thrombosis which extended both proximally and distally 4].Excision of the osteochondroma was warranted as it was the aetiological factor. The patient was counselled for surgery and put on warfarin. However, the patient was not willing for surgery. The patient was asymptomatic at six months follow up and colour doppler was done at 6 months which showed reduction in size of the aneurysm [Table/ Fig-5]. DisCussionThe most common benign tumour of the skeleton is osteochondroma, which occurs in approximately 1% of the population with a greater male preponderance. They are located in the metaphyses, most commonly in the distal femur and develop from the cortical bone dysplasia at the epiphyseal plate [1]. They are protected by a soft cartilageous cap which undergoes ossification following skeletal maturity. These are most commonly solitary, however, multiple lesions may exist as a part of hereditary multiple exostosis [1]. They are mostly asymptomatic, however most common presentations Osteochondroma is the most common benign skeletal tumour. It frequently causes pain and local symptoms, however, vascular complications are rare. The popliteal artery is more commonly affected and there are isolated case reports of popliteal artery pseudoaneurysm in literature. However, venous complications are extremely rare. We hereby report a case of 21-year-old male patient with distal femoral osteochondroma complicated by a popliteal venous aneurysm and deep vein thrombosis. This association has not been described in the past. The patient was put on anticoagulants as he refused surgery and was asymptomatic at six months follow-up. Awareness of this complication is important for timely diagnosis and surgical management as it is a source of life threatening pulmonary thromboembolism. The popliteal venous aneurysm is seen as a non-opacified...

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

“…Gouicem et al 19 described a common carotid artery occlusion from a clavicle osteochondroma that was resected, and Altaf et al 20 described vertebral artery occlusion from a first cervical vertebra osteochondroma managed with anticoagulation. Sethi et al 21 described a popliteal vein aneurysm managed conservatively. One case of arteriovenous fistula in which a popliteal pseudoaneurysm eroded into the accompanying vein has been reported.…”

Diagnostic imaging of deep vein thrombosis secondary to osteochondroma formation

“…Pseudoaneurysm from an adjacent artery and mass effect of a large volume exostosis can lead to venous occlusion and ultimately deep venous thrombosis. 9 – 12 An isolated DVT with no arterial involvement, however, is far less common. To our knowledge, there are fewer than five cases identifiable in the literature.…”

Tratamento de aneurisma de artéria poplítea bilateral

“…3 Among younger patients, a relationship has been observed with osteochondroma. 4,5 In the majority of cases, these aneurysms are asymptomatic, although as volume increases they can cause pain and edema due to compression of nerves and veins. 6 Popliteal artery aneurysms rarely rupture and their most significant complications are thrombosis and embolization.…”