J Korean Orthop Assoc.  2013 Aug;48(4):297-301.

Rupture of a Brachial Artery Caused by a Humeral Osteochondroma

• Kong CB
• Lee KY
• Cho SH
• Song WS
• Cho WH
• Jeon DG
• Lee SY

Abstract

Pseudoaneurysm resulting from vascular impingement by an osteochondroma is extremely rare. The authors report on the case of a 16-year-old male who had a brachial artery pseudoaneurysm and vessel rupture associated with a humeral osteochondroma. This case suggests that pseudoaneurysm should be considered for the differential diagnosis in patients with soft tissue masses and a cuspidal osteochondroma located near the neurovascular bundle and recommends Doppler sonography or angiography.

Keyword

pseudoaneurysm; osteochondroma; brachial artery; vascular grafting

MeSH Terms

Aneurysm, False
Angiography
Brachial Artery
Cuspid
Diagnosis, Differential
Glycosaminoglycans
Humans
Male
Osteochondroma
Rupture
Vascular Grafting
Glycosaminoglycans

Figure

• 

  Figure 1 (A) Plain radiograph shows a left proximal humeral osteochondroma. (B) Three-dimentional reconstructed computed tomography (CT) image shows a medially protruded humeral osteochondroma. (C) Axial CT image demonstrates that this osteochondroma has a sharp beak toward the brachial neurovascular bundle.

• 

  Figure 2 (A) The shoulder T1 and (B) T2-weighted magnetic resonance (MR) axial images demonstrate soft tissue mass. (C) Enhance T1-weighted MR axial image shows pseudoaneurysm (arrow) arising from the compressed brachial artery which demonstrate a strong enhancement. (D) T2-weighted MR shows that this soft tissue mass has high signal intensity along the intermuscular septum.

• 

  Figure 3 (A) Intra-operative picture showing left brachial artery with associated pseudoaneurysm and hematoma. (B) The picture shows that additional incision and artificial vessel graft were performed.

• 

  Figure 4 (A, B) Post-operative plain radiographs show excised osteochondroma in the proximal medial meta-diaphysis of the left humerus. (C) Two months later after the operation, doppler ultrasonography shows vascular access dysfunction at the axillary artery and proximal arm.

Reference

1. Eschelman DJ, Gardiner GA Jr, Deely DM. Osteochondroma: an unusual cause of vascular disease in young adults. J Vasc Interv Radiol. 1995; 6:605–613.

2. Scotti C, Marone EM, Brasca LE, et al. Pseudoaneurysm overlying an osteochondroma: a noteworthy complication. J Orthop Traumatol. 2010; 11:251–255.

3. Vasseur MA, Fabre O. Vascular complications of osteochondromas. J Vasc Surg. 2000; 31:532–538.

4. Kim YJ, Baek WK, Kim JY, et al. Pseudoaneurysm of the popliteal artery mimicking tumorous condition. J Korean Surg Soc. 2011; 80:Suppl 1. S71–S74.

5. Bilotta W, Walker H, McDonald DJ, Sundaram M. Case report 651: thrombosed, leaking popliteal aneurysm. Skeletal Radiol. 1991; 20:71–72.

6. Mann HA, Hilton A, Goddard NJ, Smith MA, Holloway B, Lee CA. Synovial sarcoma mimicking haemophilic pseudotumour. Sarcoma. 2006; 2006:27212.

7. Hermann G, Abdelwahab IF, Miller TT, Klein MJ, Lewis MM. Tumour and tumour-like conditions of the soft tissue: magnetic resonance imaging features differentiating benign from malignant masses. Br J Radiol. 1992; 65:14–20.

8. Tobias AM, Chang B. A rare brachial artery pseudoaneurysm 13 years after excision of a humeral osteochondroma. Ann Plast Surg. 2004; 52:419–422.

9. Gerrand CH. False aneurysm and brachial plexus palsy complicating a proximal humeral exostosis. J Hand Surg Br. 1997; 22:413–415.

10. Longo JM, Rodríguez-Cabello J, Bilbao JI, Aquerreta JD, Ruza M, Mansilla F. Popliteal vein thrombosis and popliteal artery compression complicating fibular osteochondroma: ultrasound diagnosis. J Clin Ultrasound. 1990; 18:507–509.