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.
References
1. Reijnders C, Hameetman L, VMG Bovée J. Bone: Osteochondroma. Atlas Genet Cytogenet Oncol Haematol. 2009;13(9):678–80.
2. Kitsoulis P, Galani V, Stefanaki K, Paraskevas G, Karatzias G, Agnantis NJ, et al. Osteochon-dromas: review of the clinical, radiological and pathological features. Vivo Athens Greece. 2008 Oct;22(5):633–46.
3. Wuyts W, Schmale GA, Chansky HA, Raskind WH. Hereditary Multiple Osteochondromas. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJ, Stephens K, et al., editors. Ge-neReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993 [cited 2019 Mar 28]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK1235/
4. Herget GW, Kontny U, Saueressig U, Baumhoer D, Hauschild O, Elger T, et al. [Osteochon-droma and multiple osteochondromas: recommendations on the diagnostics and follow-up with special consideration to the occurrence of secondary chondrosarcoma]. Radiol. 2013 Dec;53(12):1125–36 (in German).
5. Raherinantenaina F, Rakoto-Ratsimba HN, Rajaonanahary TMA. Management of extremity arterial pseudoaneurysms associated with osteochondromas. Vascular. 2016 Dec;24(6):628–37.
6. Turley K, Watson R, Joseph T. Osteochondroma. In: Health Encyclopedia – University of Rochester Medical Center [Internet]. 2014 [cited 2019 Mar 28]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00125
7. Nasr B, Albert B, David CH, Marques da Fonseca P, Badra A, Gouny P. Exostoses and vascu-lar complications in the lower limbs: two case reports and review of the literature. Ann Vasc Surg. 2015 Aug;29(6):1315.e7-1315.e14.
8. Beauchamp-Chalifour P, Pelet S. Osteochondroma of the Scapula with Accessory Nerve (XI) Compression. Case Rep Orthop [Internet]. 2018 [cited 2019 Mar 28]; Available from: https://www.hindawi.com/journals/crior/2018/7018109/
9. Aldashash F, Elraie M. Solitary osteochondroma of the proximal femur causing sciatic nerve compression. Ann Saudi Med. 2017;37(2):166–9.
10. Payne R, Sieg E, Fox E, Harbaugh K, Rizk E. Management of nerve compression in multiple hereditary exostoses: a report of two cases and review of the literature. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg. 2016 Dec;32(12):2453–8.
11. Aouini F, Garali W, Saaidi A, El Mahdi A, Mechergui S, Jabeur C, et al. [Nerve and deep vein compression by femoral artery pseudoaneurysm in a patient with multiple exostosis]. Ann Cardiol Angeiol (Paris). 2015 Apr;64(2):113–5 (in French).
12. Göçmen S, Topuz AK, Atabey C, Şimşek H, Keklikçi K, Rodop O. Peripheral nerve injuries due to osteochondromas: analysis of 20 cases and review of the literature. J Neurosurg. 2014 May;120(5):1105–12.
13. Gerrand CH. False aneurysm and brachial plexus palsy complicating a proximal humeral exos-tosis. J Hand Surg Edinb Scotl. 1997 Jun;22(3):413–5.
14. Lucarelli DD, Subram A. Type IV popliteal arterial entrapment associated with an osteochon-droma. J Vasc Surg Cases Innov Tech. 2017 Apr 25;3(2):66–8.
15. Ruales Romero AM, Doiz Artazcoz E, Craven-Bartle Coll A, Gonzalez Calbo A, Rodríguez Piñero M. Thrombosed Popliteal Artery Pseudoaneurysm as Herald of Tibial Osteochondroma. EJVES Short Rep. 2016 Oct 17;33:27–31.
16. Gouicem D, Palcau L, Hello CL, Coffin O, Maiza D, Berger L. Gigantic clavicle osteochon-droma with carotid compression as a rare cause of stroke. J Vasc Surg. 2013 Mar;57(3):845–7.
17. Joo Han O, Kim JY, Kang M, Bae T, Lee T. Deep Vein Thrombosis Associated with Femur Osteochondroma: Report of a Case. Ann Vasc Dis. 2009;2(3):178–81.
18. Yasuda N, Nakai S, Nakai T, Outani H, Takenaka S, Hamada K, et al. A pseudoaneurysm of the popliteal artery probably pierced by a bone spike arising in the spontaneously regressed os-teochondroma: A case report. J Orthop Sci [Internet]. 2018 Oct 11 [cited 2019 Mar 28];0(0). Available from: https://www.journaloforthopaedicscience.com/article/S0949-2658(18)30253-7/abstract
19. Bateman DK, Bar-Eli HY, Rahimi SA, Bowe JA. Post-traumatic pseudoaneurysm of brachial artery in multiple hereditary exostoses. BMJ Case Rep. 2018 Jun 27;2018.
20. Takahashi A, Uchida T, Hamasaki A, Kuroda Y, Eiichi O, Yamashita A, et al. Popliteal Artery Pseudoaneurysm Associated with Osteochondroma. Ann Vasc Dis. 2017 Sep 25;10(3):257–60.
21. Sakata T, Mogi K, Sakurai M, Nomura A, Fujii M, Takahara Y. Popliteal Artery Pseudoaneu-rysm Caused by Osteochondroma. Ann Vasc Surg. 2017 Aug 1;43:313.e5-313.e7.
22. Papacharalampous G, Galyfos G, Geropapas G, Giannakakis S, Maltezos C. False Arterial Aneurysm due to Long Bone Exostosis: Presentation of Two Cases and Update on Proper Management. Ann Vasc Surg. 2015;29(4):842.e19-22.
23. Gyedu, Arslan, Koksoy. Hand ischemia caused by solitary humeral exostosis irritating the brachial artery. Vasa. 2011 Jul 1;40(4):320–2.
24. Nevelsteen A, Pype P, Broos P, Suy R. Brachial artery rupture due to an exostosis: brief report. J Bone Joint Surg Br. 1988 Aug;70-B(4):672–672.
25. Scotti C, Marone EM, Brasca LE, Peretti GM, Chiesa R, Del Maschio A, et al. Pseudoaneu-rysm overlying an osteochondroma: a noteworthy complication. J Orthop Traumatol Off J Ital Soc Orthop Traumatol. 2010 Dec;11(4):251–5.
26. Villanueva-Garcia E, Bas-Hermida P, Espinosa-Lledo C. Pseudoaneurysm of the brachial ar-tery caused by an osteochondroma. A report of two cases. Int Orthop. 1995;19(4):248–50.
27. Koenig SJ, Toth AP, Martinez S, Fletcher JW, Goldner RD. Traumatic Pseudoaneurysm of the Brachial Artery Caused by an Osteochondroma, Mimicking Biceps Rupture in a Weightlifter: A Case Report. Am J Sports Med. 2004 Jun 1;32(4):1049–53.
28. Katayama T, Ono H, Furuta K. Osteochondroma of the lunate with extensor tendons rupture of the index finger: a case report. Hand Surg. 2011 Jan 1;16(02):181–4.
29. Cho C-H, Jung G-H, Song K-S, Min B-W, Bae K-C, Lee K-J. Osteochondroma of the bicipital tuberosity causing an avulsion of the distal biceps tendon. Orthopedics. 2010 Nov 2;33(11):849.
30. Kim JP, Seo JB, Kim MH, Yoo MJ, Min BK, Moon SY. Osteochondroma Associated With Complete Rupture of the Distal Biceps Tendon: Case Report. J Hand Surg. 2010 Aug 1;35(8):1340–3.
31. Canella P, Gardini F, Boriani S. Exostosis: development, evolution and relationship to malig-nant degeneration. Ital J Orthop Traumatol. 1981 Dec;7(3):293–8.
32. Garrison RC, Unni KK, McLeod RA, Pritchard DJ, Dahlin DC. Chondrosarcoma arising in osteochondroma. Cancer. 1982 May 1;49(9):1890–7.
33. Tobias A, Chang B. A Rare Brachial Artery Pseudoaneurysm 13 Years After Excision of a Humeral Osteochondroma. Ann Plast Surg. 2004 Apr 1;52(4):419–22.
34. Vasseur M-A, Fabre O. Vascular complications of osteochondromas. J Vasc Surg. 2000 Mar 1;31(3):532–8.
How to Cite this article: Górecki M, Czarnecki P. 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 Jan- June 2019;3(1):3-6. |