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In this report, we present a case of a 32-year-old female previously diagnosed with hereditary multiple exostoses(HME) who was incidentally found to have an asymptomatic anterior mediastinal mass during a routine examination. Computed tomography imaging revealed a well-defined mass measuring approximately 2.3 cm x 4.

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Hereditary multiple exostoses (HME), an autosomal dominant disorder with an incidence of 1:50,000 to 1:100,000, is characterised by the formation of multiple osteochondromas arising from the metaphyses of long and flat bones. These osteochondromas often present as painless palpable lumps, though some cases are symptomatic due to mechanical compression or bursitis. Diagnosis of HME is typically clinical and radiological.

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Hereditary multiple exostoses (HME) is an autosomal dominant condition with variable penetrance. As per Dr Waller's audit of the Leeds regional bone tumour registry, 90 primary bone tumours of the thoracic skeleton were recorded, accounting for 4.5% of all cases in the registry.

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Background: Hereditary multiple osteochondromas (HMO) are benign neoplasms that predominantly affect the bones around the knee joint, proximal humerus, wrist, pelvis, and to a lesser extent, the rib. Although rib-origin osteochondromas are uncommon and often asymptomatic, they can lead to pleural, pericardial, and diaphragmatic injuries secondary to tumour related pressure. We are presenting a unique case of a vascular-related giant osteochondroma rib that is hereditary, originating from the right second, third, and fourth ribs causing compression symptoms in a young child.

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Multiple hereditary exostoses (MHE) is a rare skeletal disorder inherited as an autosomal dominant disorder. It is characterized by widespread multiple osteochondromas that grow near bone growth plates, leading to pain and deformities that significantly impact physical and emotional well-being and disrupt daily activities, social interactions, and psychological health, leading to considerable disability. This case report describes a 15-year-old boy with a family history of MHE who developed a large osteochondroma at his right elbow.

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