Vascular complications of tibial exostosis: A rare case of popliteal vein deep venous thrombosis

Abstract

Introduction and importance

Tibial exostosis (osteochondroma) represents a prevalent benign bone tumor typically identified in young adults. Uncommonly, vascular complications can emerge, encompassing vessel perforation, thrombosis and arterial thromboembolic events. Rare instances of popliteal vein thrombosis resulting from tibial osteochondroma have been documented.

Case presentation

We report a rare case of a 25-year-old patient who presented with a red and swollen leg, and the diagnosis of deep venous thrombosis (DVT) of the left popliteal vein was established. The patient also exhibited a painless, hard swelling in the popliteal fossa. Radiography revealed an exostosis on the posterior aspect of the proximal tibia. An angioscan demonstrated close relations with the popliteal vessels, leading to venous compression. The patient underwent resection through a posterior knee approach. Histopathological analysis of the exostosis ruled out malignant transformation.

Clinical discussion

The discussion emphasizes the need for prompt diagnostic measures when signs indicate a vascular concern in a young patient, initiating with a radiograph followed by Doppler ultrasound and/or angiography to diagnose complications and precisely delineate their relationships with the tumor.

Surgical intervention is underscored as urgent, particularly in cases involving arterial thrombosis, where immediate measures such as thrombectomy or bypass with a venous graft may be necessary.

Conclusion

Vascular complications associated with bone exostoses are rare but require prompt surgical treatment. However, it should prompt the performance of an angioscan in the presence of any abnormalities during clinical examination or an appearance raising concerns about potential vascular conflict.

Highlights

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  Tibial exostosis represents a prevalent benign bone tumor.

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  Uncommonly, vascular complications can emerge, encompassing vessel perforation, thrombosis, arterial thromboembolic events, and pseudoaneurysm formation.

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  Rare instances of popliteal artery thrombosis and acute lower limb ischemia resulting from tibial exostosis have been documented.

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  Vascular complications associated with bone exostoses are rare but require prompt surgical treatment.