Imaging Case of the Week 90

The following proximal right humerus x-ray is from a 40 year old who experienced a minor fall and is tender over the insertion of the supraspinatus. What can you see?

right shoulder

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The area of interest, the greater tubercle, looks okay. There is an incidental finding of a bony lesion in the proximal humerus with stippled calcification. This is an enchondroma.

Enchondroma proximal humerus

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An enchondroma is a benign bony lesion and contains calcified chondroid matrix. It appears as an area of stippled punctate calcification in any location in the skeleton except in the phalanges where it appears as a lytic lesion.

If there is any pain associated with an enchondroma, the patient will need an orthopaedic referral for a biopsy to rule out malignant transformation (chondrosarcoma).

Reference: Fundamentals of diagnostic radiology by Brant and Helms