Clinical Images

Pericarditis

 Matt Mathew, B.S., Patrick Williams, D.O., Jennifer McRae, M.D., Erica E. Howe, M.D.
January 7, 2015

A 20-year-old man with a past medical history of hereditary multiple osteochondromas (HMO) presented with a one-day history of persistent chest pain exacerbated by deep inspiration and exertion. His physical exam was significant for multiple palpable bony masses of the appendicular skeleton. Initial EKG showed a diffuse ST elevation pattern consistent with acute pericarditis, and pertinent lab findings demonstrated elevated troponin, erythrocyte sedimentation rate, C-reactive protein, and D-dimer. A computed tomography (CT) scan revealed a bony mass extending from the posterior aspect of the left fourth rib and abutting the pericardium (Figure 1).  Echocardiogram revealed the same and demonstrated a normal ejection fraction and no pericardial effusion.  Resection of the chest wall bony mass with partial fourth rib resection was performed by video-assisted thoracoscopy (Figure 2).  Pathology confirmed osteochrondroma. 

Figure 1

Figure 2

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References:
1. Ahmed AR, Tan TS, Unni KK, Collins MS, Wenger DE, Sim FH. Secondary chondrosarcoma in osteochondroma: report of 107 patients. Clin Orthop Relat Res. 2003 June; (411): 193-206.

2. Bovee JV.  Multiple osteochrondromas.  Orphanet J Rare Dis.  Feb 2008, 3:3.

Brief Bios:

Matt Mathews, B.S. is a third-year medical student; Patrick Williams, M.D. is a preliminary radiology intern, Jennifer McRae, M.D. is a second-year Internal Medicine resident, and Erica Howe, M.D. is an Assistant Professor and works as a Hospitalist in the Division of General and Geriatric Medicine.  All authors work at the University of Kansas Medical Center in Kansas City, Kansas.