Transient bone oedema of the tibia mimicking a tumorous process

D. Robinson, Y. Kossashvili, J. Sandbank, N. Halperin, D. Alk

Research output: Contribution to journalArticlepeer-review

Abstract

The authors describe a distinct clinical entity consisting of bony tenderness, increased isotope uptake along the metaphyses and/or diaphyses and magnetic resonance changes simulating a bone marrow- replacing lesion. Bone biopsies indicate the presence of bone marrow fibrosis and some new bone formation. Nine such cases were prospectively evaluated according to a standardized protocol including clinical examination, xrays, bone scan and CT scan as well as MRI scans including contrast medium injection. All patients presented with tibial tenderness. In one case the bone was noticeably thicker as compared to the other side. The ages ranged from 6 years to 64 years and 6 of the patients were female. Xrays were normal in 6/9 patients; the rest had minimal periosteal reaction, and mild intramedullary sclerosis. Uniform imaging findings were longitudinal increased uptake along the metadiaphysis of the tibia on bone scans, and increased bone marrow density on CAT scans without a fracture line. A magnetic resonance study indicated bone marrow replacement as demonstrated by an area of low signal intensity on T1-weighted images and high signal intensity on T2weighted images. Some enhancement of signal was observed following gadolinium injection. This clinical entity, which the authors attribute to be a medullary stress reaction, is self-limited, and pain resolves within 3 months. However the radiographic changes appear to be permanent. A biopsy is not required provided no cortical penetration or soft tissue mass is demonstrated by MRI scan.

Original languageEnglish
Pages (from-to)157-162
Number of pages6
JournalActa Orthopaedica Belgica
Volume68
Issue number2
StatePublished - 2002
Externally publishedYes

Keywords

  • Bone bruise
  • Bone tumors
  • Bonemarrow fibrosis
  • Stress fractures

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