Intraosseous venous drainage anomaly in patients with pretibial varices: imaging findings

To determine a set of distinctive imaging findings seen in symptomatic patients with pretibial varices.

Medical records and imaging studies of patients who presented with pretibial varices over an 8-year period were collected from four institutions. Findings in six symptomatic patients with pretibial varices were retrospectively reviewed. Radiographic and magnetic resonance (MR) imaging findings were available from all six patients; findings from several other modalities were also available in some patients.

Conventional radiographs showed a small osteolytic defect in the anterior cortex of the midtibia and a prominent, longitudinally oriented, radiolucent groove in the proximal half of the tibial diaphysis. MR images showed pretibial varices connected to an enlarged vessel in the tibia that eventually exited through the nutrient foramen. Computed tomographic (three patients), sonographic (four patients), venographic (four patients), arteriographic (two patients), and surgical (three patients) findings demonstrated that these patients had an unusual intraosseous varix that traversed the anterior cortex, medullary cavity, and posterior cortex of the tibia.

Recognition of these findings can prevent misdiagnosis and may prove helpful in the planning of appropriate treatment.