Introduction: Primary rib neoplasms are uncommon, making up only 5-10% of all bony tumors and 5% of thoracic neoplasms. Primary rib neoplasms are also not typically considered in the list of common differential diagnoses for thoracic musculoskeletal pain alongside conditions such as costochondritis. Additionally, primary rib neoplasms can present similar to other conditions, such as Tietze Syndrome. Because of the prevalence of primary rib neoplasms as well as its wide range of presenting symptoms, the time to diagnosis is typically prolonged. Primary rib neoplasms are typically treated surgically. We discuss a patient presenting with a 5-year history of intermittent left chest pain who was found to have a chondroid lesion of the left rib after years of extensive cardiac and radiologic workup. This case highlights the importance for physicians to consider primary rib neoplasms in the differential for patients with musculoskeletal chest pain.

Clinical Vignette Summary: A 39 y/o F with a PMH of bilateral avascular necrosis of the hips presents with a 5-year history of intermittent left chest pain. Patient reports that the pain began after shutting the hatchback of a car in 2018. She notes that the pain is exacerbated by movement of her left arm and shoulder and occurs roughly once a week. Patient was initially given a diagnosis of costochondritis in 2018. However, in 2021, an EKG and Echo were ordered due to patient report of chest tightness; both tests returned within normal limits. In November 2022, extensive imaging was conducted due to persistence of pain. CT Chest w/o contrast revealed a 10 x 5 mm lesion in the left third costal cartilage with appearance of a benign chondroid lesion, corresponding with a T2 hyperintense focus on MRI of the Left Upper Extremity. Patient was sent to Cardiothoracic Surgery for evaluation and ultimately opted for conservative management with acupuncture and topical diclofenac and lidocaine due to stability of symptoms.

Conclusions/Clinical Relevance: This case highlights the importance of broadening one’s differential when it comes to the workup of musculoskeletal pain. While diagnoses such as costochondritis are common causes of musculoskeletal pain, quickness to diagnose patients with this condition may lead clinicians to miss other potentially more serious causes of musculoskeletal pain.