Isolated first rib fracture in athletes.

Isolated fractures of the first rib are uncommon. They are caused by major blunt trauma, a violent muscular pull, or fatigue. Diagnosis is usually made by chest radiography and computed tomography. Angiography is justified when certain criteria are met. Treatment is rest and mild analgesia. Early and late complications have been reported and are treated accordingly. The purpose of this article is to report a case of first rib stress fracture in a kick boxer and review the pertinent literature.

Tumors of the ribs: experience with 47 cases.

OBJECTIVES: To emphasise the existing difficulties in differentiating benign from malignant rib tumours, and especially the problems that a clinical doctor encounters when dealing with a hyperplastic rib. METHODS: Forty-seven patients with rib tumour underwent surgery in a period of 12 years (1984-1996). In 40 cases (85%), the lesion was benign and in seven (15%) was malignant. Twenty-one benign tumours originated from cartilage and bone, seven were inflammatory, six originated from the bone marrow, and minor percentages (2.5-5%) had vascular, neurogenous, degenerative or miscellaneous origin. Three of the malignant tumours were primary chondrosarcomas and two were metastatic from kidney. The rest were metastatic from stomach (adeno-Ca), and skin (melanoma). The mean age in the benign group was 25.2 years and in the primary malignant group was 20.7 years. Related symptoms were pain (47%) and swelling (42.5%). One-third (32%) of the patients were asymptomatic and the lesion was accidentally found during routine chest radiography. All patients were treated surgically with wide excision of the tumour and the diagnosis was established histologically. RESULTS: Resection was complete and curative in all cases without recurrence. CONCLUSIONS: Since the likelihood of malignancy cannot be excluded, all rib tumours should be considered malignant until proven otherwise. Therefore, prompt intervention is necessary and wide and radical initial excision of the involved rib is advocated.

Salmonella osteomyelitis of the rib.

Salmonella rib osteomyelitis is extremely rare; we found only one previously reported case. A 33-year-old man presenting with a discharging sternal sinus was diagnosed by means of computed tomography and bone isotope scans and confirmed by excision of the affected portion of the rib. The operation was curative.

Gigantic primary lipoma of the diaphragm presenting with respiratory failure.

Primary diaphragmatic lipomas are rare. A 66-year-old female case is reported, with the unusual presentation of progressive dyspnoea leading to respiratory failure, mainly because of a large fatty mass occupying the base of the left hemithorax. The completely resected mass (16 x 14.5 x 5.5 cm) was a primary diaphragmatic lipoma. The literature is discussed. We recommend surgical exploration since the possibility of liposarcoma cannot be excluded.

Pulmonary xanthoma. A case report with immunohistologic study and DNA-image analysis.

A case is reported of a xanthoma of the lung in a 32-year-old asymptomatic male. Detailed roentgenographic and immunohistopathologic studies, as well as DNA-image analysis, are presented. The benign nature of this tumor is well recognised and it is generally agreed that conservative local excision with a margin of uninvolved lung is the treatment of choice. The existing literature is reviewed.