Differential Diagnosis

• Single most likely diagnosis
  • Enchondroma: This is mentioned in the impression as a possible cause for the tiny nonspecific nonaggressive appearing lucency within the central shaft of the third proximal phalanx. Enchondromas are benign cartilaginous tumors that can present as well-defined lucencies in the bones of the hands, which aligns with the findings.
• Other Likely diagnoses
  • Bone cyst: A bone cyst, such as a simple (unicameral) bone cyst, could also present as a well-defined lucency and might be considered given the nonaggressive appearance.
  • Intraosseous ganglion: These are benign lesions that can appear as cystic changes within the bone and might be considered in the differential for a nonaggressive-appearing lucency.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Osteoid osteoma: Although typically presenting with a nidus surrounded by sclerosis, an osteoid osteoma could potentially appear as a small lucency, especially if the sclerosis is not prominent. Missing this diagnosis could lead to unnecessary prolonged pain and disability.
  • Bone metastasis: While less likely given the small size and nonaggressive appearance, a metastatic lesion could present as a solitary lucency. Given the potential severity of metastatic disease, this should not be entirely ruled out without further investigation if clinically indicated.
• Rare diagnoses
  • Chondromyxoid fibroma: A rare benign tumor that could present as a lucency but is less common than enchondroma.
  • Giant cell tumor: Typically presents in a more aggressive manner but could be considered in the differential for any bone lesion, especially if the patient is of appropriate age (usually after skeletal maturity).