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Osteochondroma

Howard T Heller, MD
Piran Aliabadi, MD

April 26, 1996

Presentation

A 30-year-old man presented with a five-week history of bilateral lower extremity weakness. Symptoms were more severe on the right.

Imaging Findings

Plain radiographs of the chest
MRI of the T3/T4 vertebrae

Posteroanterior (PA) and lateral radiographs of the chest show a 3 cm densely calcified mass at the left apex adjacent to the T4 vertebral body (arrows).

On magnetic resonance images (MRI) a minimally enhancing mass at the T3/ T4 level extends into the neural foramen (arrows), resembling a dumbbell lesion with epidural compression of the thoracic cord (arrow), displacing it anteriorly and to the right.

Differential Diagnosis

Differential diagnosis includes chondroid lesion (such as osteochondroma or chondrosarcoma) and nerve sheath tumor (such as schwannoma or neurofibroma, although calcification in these is rare).

Diagnosis

Osteochondroma

Discussion

Osteochondromas are most often seen in the second or third decade of life, although they are thought to be congenital lesions arising from displaced or aberrant growth plate cartilage. They may also arise in children with open growth plates who have been irradiated. Spontaneous regression is uncommon and, if necessary, surgical excision is the treatment of choice. Osteochrondromas are most frequently seen in the metaphysis of long bones but may occur in any bone that develops by enchondral bone formation. The cortex of adjacent normal bone is continuous with that of the osteochondroma, a distinguishing feature from other bone tumors. Osteochondromas are usually asymptomatic unless blood vessels or nerves are involved (as in this patient).

References

1. Edeiken J, Dalinka M, Karasick D. Edeiken's Roentgen diagnosis of diseases of bone. 4th ed. Baltimore: Williams & Wilkins, 1990; 95-110.

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