Niyazi İğde, Osman Emre Aycan, Berkay Doğan, Berksu Polat, Serhat Gürbüz
Joint Diseases and Related Surgery - 2026;37(2):402-412
Objectives: This study aims to evaluate the incidence, distribution, clinical implications, and surgical criteria for intrathoracic osteochondromas in hereditary multiple osteochondroma (HMO) patients. Patients and methods: Between January 2010 and January 2024, a total of 246 patients (146 males, 100 females; mean age: 8.2 +/- 4.5 years; range, 1 to 18 years) who were diagnosed with HMO and had thoracic imaging using computed tomography (CT) with at least one year of clinical follow-up were retrospectively analyzed. Lesion characteristics (type, size, number, and location), symptoms, and surgical data were recorded. The receiver operating characteristic (ROC) curve analysis was performed to identify the size threshold associated with surgical indication. Results: Intrathoracic osteochondromas were detected in 35% of chest X-rays and in 81.8% of CT scans. Among 45 CT-confirmed cases, 68.9% had multiple lesions and 77.8% were pedunculated. Surgical excision was performed in 12 patients (4.9%), most commonly due to chest pain or paracardiac location. Tumor size was significantly higher in excised cases (median: 26 mm vs. 12 mm, p < 0.001). A lesion size > 15 mm predicted surgical need with 91.67% sensitivity and 72.73% specificity (area under the curve [AUC] = 0.883, p < 0.001). Conclusion: Routine chest radiography, reinforced by selective thoracic CT in symptomatic or suspicious cases, should be integrated into the follow-up of HMO patients to detect intrathoracic osteochondromas early. A lesion size of > 15 mm, chest pain, and paracardiac localization are strong predictors of surgical intervention and should guide clinical decision-making.
