Distal femoral osteochondroma masquerading as deep vein thrombosis in an adolescent male

Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma

Introduction:

Vascular complications occurring secondary to osteochondroma are a rare phenomenona. They typically present insidiously with claudication, however, uncommonly may present with acute limb ischaemia. We present a case of a young boy who presented with acute limb ischaemia secondary to osteochondroma with an intraoperative diagnosis of popliteal pseudoaneurysm.

Case Report:

A 15-year-old male presented with an acutely ischaemic limb. A computed tomography CT angiogram was performed which demonstrated complete occlusion of his popliteal artery secondary to a tumour of the distal femur. The patient underwent an open biopsy of the tumour followed by thrombectomy which failed to resolve the ischaemia. After further unsuccessful attempts at thrombectomy, angiography was performed which revealed a pseudoaneurysm. . The patient underwent a successful popliteal exclusion bypass using ipsilateral reversed long saphenous vein. The lesion was subsequently identified as an osteochondroma. The patient made a good recovery and at his latest follow-up is ambulant, free from claudication, and demonstrates good flow through the bypass on duplex ultrasonography.

Conclusion:

Acute limb ischaemia is a rare occurrence within the adolescent population and will, therefore, frequently be secondary to an uncommon aetiology. Whilst While osteochondroma are is a common cause of vascular complications in this population, the onset of symptoms is usually more insidious. The acute onset, in this case, therefore, raised uncertainty as to the potential for malignancy. The management of these patients should involve a combination of both vascular and orthopaedic surgery in order to return perfusion whilest also ensuring the offending lesion is managed appropriately. In patients where initial measures do not restore perfusion, then the potential for further complications such as pseudoaneurysm should be considered and managed promptly.

Diagnostic imaging of deep vein thrombosis secondary to osteochondroma formation

Deep vein thrombosis (DVT) is a condition classically associated with blood stasis, hypercoagulability or injury to the vasculature. As blood stasis is usually associated with patient immobility, DVT occurrence in young active patients with no underlying haematological conditions is a rarity. An exostosis, also known as osteochondroma, is a cartilage capped lesion. If solitary, they represent low malignant potential and unless symptomatic, they are rarely excised. A 23-year-old, active male, presented to hospital with pain and swelling in the left lower leg. It was a deep, non-radiating pain, exacerbated by exercise. Wells' criteria score for DVT was 2. An ultrasound was performed which identified thrombosis in the superficial femoral, and popliteal veins. Haematological causes of thrombosis were ruled out. X-ray showed a posterior femoral exostosis. It was determined that compression by the exostosis was the cause of the thrombosis. We present a case of a DVT secondary to osteochondroma formation in a young male. Isolated DVT in this setting is uncommon with fewer than five previously reported cases identified in the literature. We also discuss the current literature and management of this rare entity.

Osteochondroma Complicated by a Popliteal Vein Aneurysm- A Rare Case Report

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.