A brachial artery pseudoaneurysm in the form of a “malignant tumour” as a complication of a proximal humerus exostosis

Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 3-6 | Michał Górecki, Piotr Czarnecki

Authors: Michał Górecki [1], Piotr Czarnecki [2].

[1] Student Research Group of Hand Surgery, University of Medical Sciences Poznań, Poland
[2] Department of Traumatology, Orthopaedics and Hand Surgery of Viktor Dega Orthopedic and Rehabilitation Clinical Hospital

Address of Correspondence
Dr. Michał Górecki,
Mścibora 74, 61-062 Poznań, Poland
E-mail: michalmgorecki@gmail.com

Abstract

Background: Osteochondromas are the most common form of benign bone tumour. They are mostly asymptomatic, but sometimes they can irritate surrounding structures, like vessels or nerves, and cause complications. More often they apply to the lower extremities, especially around the knee joint. Osteochondromas which cause complications in the upper extremities are much less common. This paper presents a rare case of a brachial artery pseudoaneurysm as a complication of a proximal humerus exostosis, which was initially described and treated as malignant tumour of the arm. A comprehensive review of the literature has also been carried out.
Methods: A 19-year-old male patient was admitted with acute pain of the left arm. Eight years earlier he had been diagnosed with hereditary multiple osteochondromas. Examination revealed a palpable, non-painful tumour of the axilla’s area and the posterior part of the left arm. An magnetic resonance imaging (MRI) with contrast demonstrated three osteochondromas in the area of the proximal humerus. From the free end of one of these, a big, nodular structure was spreading. From the MRI, a chondrosarcoma was suspected. Samples were taken for histopathological examination. After the surgery, increased pulsations were observed around the operative area. A ultrasonography (USG) revealed a fibrotic pseudoaneurysm of the left brachial artery. Histopathological examination showed deposits of heamosiderin without any cancer cells. With the change in diagnosis, the next stage of treatment was planned – artery reconstruction using a saphenous vein graft and an osteochondroma excision.
Results: A few weeks after surgery, the patient recovered full function of the upper extremity and did not report any discomfort. A control USG showed proper flow through the brachial artery and venous graft.
Conclusion: In the case of a tumour in the area of an osteochondroma, caused by trauma, a pseudoaneurysm should be suspected. Diagnostic and therapeutic treatment must be properly planned, as unrecognised it could cause a severe, life-threatening haemorrhage during the operation.
Keywords: pseudoaneurysm, osteochondroma, malignant transformation, brachial artery, chondrosarcoma.

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