OCAD MSK

History

37M 3 weeks non-traumatic lower leg pain and swelling

Figure 1 for case osteonecrosis ( RID5180 ) — Figure 1

Figure 2 for case osteonecrosis ( RID5180 ) — Figure 2

Figure 3 for case osteonecrosis ( RID5180 ) — Figure 3

Figure 4 for case osteonecrosis ( RID5180 ) — Figure 4

Discussion

Initial radiographs show a geographic medullary lucency (red arrows) with arguable wide zone of transition and benign appearing periostitis (yellow arrow). MRI shows classic medullary infarcts in the distal tibia and calcaneal body. 2 weeks later f/u XR shows new stress fracture (white arrow) medial tibial metaphysis. Although subarticular osteonecrois leads to subarticular fatigue and articular collapse, Ive never seen stress fracture occur secondary to medullary bone infarct. Have you?

Diagnosis

osteonecrosis ( RID5180 )

Ming Huang, MD

Courtesy

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