Background:
Enchondromas, benign cartilaginous tumours, are the most common primary osseous tumour of the hand. Vascular malformations may demonstrate overlapping radiographic features to enchondromas making diagnosis difficult, but accurate distinction is important as management differs significantly. Klippel–Trénaunay syndrome is associated with vascular anomalies that can involve bone and mimic primary osseous tumours. This case, with a focused literature review, highlights this diagnostic pitfall with important management implications.
Methods/Case:
A 31 year old male with Klippel–Trénaunay syndrome presented with pain and swelling following minor trauma to the left middle finger. Plain radiographs demonstrated an expansile lytic lesion within the middle phalanx, suggestive of enchondroma with a possible pathological fracture. This would typically proceed to surgical curettage and bone grafting. Given the patient’s background, MRI with time-resolved angiography was performed, demonstrating a slow-flow intraosseous venous malformation.
Results:
The diagnosis was revised from enchondroma to intraosseous vascular malformation, the planned surgical intervention was avoided, and the patient was referred for interventional radiology management. The patient returned to baseline function without complication.
Conclusion:
This case highlights a diagnostic pitfall in hand surgery. Intraosseous vascular malformations of the hand are rare but can closely mimic enchondroma on plain radiographs. While common diagnoses are often prioritised, atypical features and patient context should prompt further investigation. In patients with underlying vascular syndromes, MRI is important for accurate lesion characterisation and can prevent unnecessary operative intervention.