Ribs and Sternum

The typically flat bones of the ribs are prone to effects of MHE, with approximately 40% of MHE patients having rib involvement. Prominent chest wall lesions are common although intrathoracic lesions including rare presentations like spontaneous hemothorax (build-up of blood and fluid in the chest cavity) as a result of rib exostoses have been described. Typically, these lesions create issues of cosmesis due to their obvious visibility.   Other symptoms may include shortness of breath and other breathing difficulties, pain when taking a deep breath, when walking or exercising, or pain from exostoses “catching”.

Diagnostic Procedures

• The orthopedist will probably manually feel for exostoses along the chest wall and the ribcage. Size and extent of the lesions are noted. A thorough pulmonary evaluation is warranted in all cases when specific symptoms of cough, chest pain or breathing problems are encountered. X-rays or other imaging tests may be ordered.

Possible Treatment Options:

• Minor bumps can sometimes be kept under observation.
• Cosmetic problems, rapid increase in size, large size, and signs of compression are some indications for early removal.
• Consult may be required with specialists:

Pulmonary: when there are severe breathing difficulties with increasing chest pain.
Thoracic surgeons: when intrathoracic (within the chest wall) exostoses may need to be excised.
 
What Parents Should Watch Out For:

• Breathing difficulties, shortness of breath
• Pain when taking deep breath.