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Case 3

19 year old male presents to a DC office complaining of non-specific left ankle discomfort. No prior history of trauma, surgery, carcinoma or corticosteroid/opioid regimen.

 

What is your diagnosis? (mouse over for answer)

Did you see the density within the left distal fibular radiolucency? This is a key to enchondroma type lesions. The sagittal MRI confirms posterior expansion with extension distally not appreciated on plain radiographs. A typical endonchroma would typically be located in the metacarpals.

DISCUSSION:  

A low grade chondrosarcoma may be a key differential consideration however,

A soft-tissue mass, periosteal reaction, cortical disruption in the juxta-articular fibula,  cortical thickening, and tumor size greater than 4.0 cm indicate chondrosarcoma over enchondroma of the fibula.1

REFERENCES:

  1. https://www.ncbi.nlm.nih.gov/pubmed/15221215# Radiographic differentiation of enchondroma from low-grade chondrosarcoma in the fibula. Kendell SD1, Collins MS, Adkins MC, Sundaram M, Unni KK

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