PMC6935969_01
(a and b) A 56-year-old female with a history of acute and increasing pain in the mid to upper left thigh. The patient informed that she was frequently climbing steep stairs. Initial radiographs demonstrated a subtle periosteal reaction only seen on a lateral view (arrow) figure a. No abnormality visualized on a-p view.
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F1
(a-d) A 56-year-old female with a history of acute pain after frequently climbing steep stairs. Four axial magnetic resonance images: T1-weighted sequence pre-contrast - on figure and subsequent post-contrast T1 image - figure c on the image below. T2-weighted sequences - figure b and subsequent T2 sequence with fat saturation on the image below - figure d. MRI showed linear, enhancing intracortical hyperintensity on both T2-weighted sequences figure b, d, and, additionally, on T1 post-contrast image figure c (arrows). Reactive edema of the adjacent soft tissues on T2-weighted images - figures b and d (arrows). There was associated post-contrast enhancement of the surrounding tissues - figure c (arrow). (e and f) A 56-year-old female with a history of acute pain after frequently climbing steep stairs. T1-TSE sagittal - figure e and T2-weighted sagittal images. Magnetic resonance imaging demonstrated linear signal abnormality at the anterior aspect of the left thigh (arrows).
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F2
Subsequent MRI revealed intra-cortical linear hyperintense signal abnormality in association with periosteal elevation, periosteal fluid, and associated muscle edema at the femoral insertion of vastus intermedius [Figure 2a-f].
(a and b) Please note the initial radiograph (3-a) for comparison , as this revealed only a subtle periosteal change in symptomatic acute phase. One year later, the same 57-year- old female with a history of acute pain after frequently climbing steep stairs. Follow-up plain radiograph was done approximately 14-month later - figure b. The female was completely asymptomatic at the time of follow-up imaging. Radiograph showed dramatic cortical thickening as a sequela of a healing process - figure b.
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F3
This was performed, and the radiograph revealed cortical thickening involving the femoral shaft in the setting of reactive changes and associated healing process [Figures 3a and b and 4a].
(a and b) One year later, the same 57-year-old female with a history of acute pain after frequently climbing steep stairs. Fourteen-month follow-up radiograph, A-P view - figure a and b. Both X-rays show extensive cortical thickening at the site of injury. Please note the post-bone biopsy image - figure b. Microscopic examination did not reveal any evidence of malignancy and confirmed benign reactive osseous changes.
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F4
This was performed, and the radiograph revealed cortical thickening involving the femoral shaft in the setting of reactive changes and associated healing process [Figures 3a and b and 4a]. The histological examination finally confirmed the suspected benign reactive periosteal reaction [Figure 4b].