UNUSUAL OSTEOCHONDROMA OF THE MEDIAL PART OF THE CLAVICLE CAUSING SUBCLAVIAN VEIN THROMBOSIS AND BRACHIAL PLEXOPATHY

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Benign primary bone tumors, including osteochondromas, rarely occur in the clavicle. We report an atypical case in which an osteochondroma developed in the medial part of the clavicle and caused thoracic outlet syndrome with primary subclavian vein thrombosis (Paget-Schroetter syndrome), brachial plexus paresthesias, and mechanical sternoclavicular pain in an otherwise healthy young man. To our knowledge, we are the first to report a case of thoracic outlet syndrome that was caused by an osteochondroma of the medial part of the clavicle. The two other medial clavicular tumors that have been reported in the literature were asymptomatic1,2. We present the natural history of this lesion and report the outcome after local excision through a clavicular osteotomy followed by internal fixation. We also discuss clavicular embryology and speculate on the pathoanatomic origin of a medial clavicular osteochondroma. The patient and his family were informed that data concerning this case would be submitted for publication. A sixteen-year-old male high-school student who worked part-time as a butcher presented to a vascular surgeon with a six-week history of insidious swelling in the left, non-dominant arm. The patient also complained of diffuse brachial plexus paresthesias. He smoked one pack of cigarettes per year but was otherwise healthy. A laboratory evaluation for thrombophilia revealed normal findings. The family history was negative for hereditary bone tumors and thromboembolism. A venogram revealed complete occlusion of the left subclavian vein along with adjacent partial obstruction of the axillary vein. Increased collateral venous drainage was present, suggesting external compression. This finding was consistent with a primary subclavian thrombosis resulting from thoracic outlet syndrome, also known as Paget-Schroetter syndrome. Routine radiographs of the chest were initially interpreted as normal, although a later retrospective review ultimately revealed the lesion. Magnetic resonance images of the shoulder revealed no obvious extrinsic …