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Age / Sex : 32 / F
Chief complaint: Pain on medial aspect of right lower leg (2 months) 1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)
Courtesy: 강창호(Chang Ho Kang), 고려대안암병원(Korea University Anam Hospital)
Diagnosis: Stress fracture
Discussion
Findings:
Localized periosteal
reaction is noted in the medial aspect of right distal tibia on plain
radiograph.
Periosteal
reaction is well-depicted on MRI with adjacent soft tissue edema. Note subtle
intracortical signal change, suggesting cortical fracture.
Differential Diagnosis:
R/O various
causes of localized periosteal reaction, especially osteoid osteoma.
Diagnosis: Stress fracture
Discussion:
Stress
injuries represent a spectrum of osseous abnormalities that occur in response
to chronic repetitive stress applied to healthy bone. Stress injuries are
common in athletes and represent approximately 10% of all injuries seen in
sports medicine clinics. Running is the activity most commonly associated with
these injuries. The vast majority of stress injuries involve the tibia followed
in order of decreasing frequency by the tarsal bones, metatarsals, femur, and
fibula.
Radiographs
are commonly used to evaluate patients with suspected tibial stress injuries.
Radiographic manifestations of stress injuries include decreased cortical
density, periosteal reaction, endosteal thickening, and a cortical fracture
line.
Magnetic
resonance imaging (MRI) has become the modality of choice at most institutions
for evaluating patients with suspected tibial stress injuries. MRI is more
sensitive than radiograph, nuclear medicine scintigraphy and CT for detecting
early stress injuries. MRI findings of stress injuries are periosteal edema,
bone marrow edema, and intracortical signal abnormality. MRI can also be used
to grade the severity of the stress injury and thereby assist in clinical
management.
References:
Kijowski R,
Choi J, Mukharjee R, de Smet A. Skeletal Radiol. 2007 Jul;36(7):633-40.
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