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July 2004
By Theodore E. Keats, MD
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A 20-year-old patient presents to the emergency department
after injuring his hand in a fistfight. In addition
to a fifth metacarpal boxer's fracture, this view of
his hand reveals an incidental lesion in the proximal
phalanx of his third finger. What is your impression
of this finding?
CLICK HERE FOR ANSWER
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ANSWER
The correct answer is enchondroma, a cartilaginous
lesion that is rather common in the hand. Enchondromas
are central lesions, originating in the medullary canal.
They thin the cortex as they enlarge and may predispose
to fracture. The inner cortex is scalloped and the lesion
itself is radiolucent. Enchondromas are usually unsuspected
by the patient until fracture occurs.
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This series of diagnostic quizzes that
challenge your ability to read a variety of x-ray films is
edited by Dr. Keats, alumni professor of radiology at the
University of Virginia School of Medicine in Charlottesville.
Emerg Med 36(7):51, 2004
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