The 3 cases presented here involve 3 unusual and different complications of costal exostoses: spontaneous hemothorax, pneumothorax, and pericardial effusion. All of the cases presented with chest pain to the emergency department. Two of the cases have hereditary multiple exostoses. All but one of the patients required surgical intervention. Complications of costal exostoses are rare, but hemothorax, pneumothorax, and pericardial effusions can occur.
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