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Published on: April 12, 2019
Transient bone oedema of the tibia mimicking a tumorous process
D Robinson1, Y Kossashvili, J Sandbank
1Department of Orthopedics, Assaf Harofe Medical Center, Zeriffin, 70300, Israel. robinson@bezeqint.net
Acta Orthopaedica Belgica
|June 8, 2002
Summary
This study identifies a distinct bone condition, a medullary stress reaction, characterized by tibial tenderness and imaging changes. It is self-limiting, with pain resolving in 3 months, though radiographic findings persist.
Area of Science:
- Orthopedics
- Radiology
- Pathology
Background:
- A distinct clinical entity presents with bony tenderness, increased isotope uptake, and MRI findings mimicking bone marrow lesions.
- Bone biopsies reveal bone marrow fibrosis and new bone formation.
Purpose of the Study:
- To prospectively evaluate a distinct clinical entity, potentially a medullary stress reaction, in nine patients.
- To define the clinical, radiographic, and MRI characteristics of this condition.
Main Methods:
- Standardized protocol including clinical examination, X-rays, bone scan, CT scan, and MRI with contrast.
- Evaluation of nine patients with tibial tenderness.
Main Results:
- Tibial tenderness was universal; X-rays were normal in most cases, showing minimal periosteal reaction or sclerosis in others.
- Bone scans revealed increased uptake in the tibial metadiaphysis; CT scans showed increased bone marrow density without fracture.
- MRI demonstrated bone marrow replacement with characteristic signal changes on T1 and T2-weighted images, and post-contrast enhancement.
Conclusions:
- The described entity, attributed to medullary stress reaction, is self-limited with pain resolving within 3 months.
- Radiographic changes are permanent; biopsy is unnecessary if MRI excludes cortical penetration or soft tissue mass.
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