PMC5390922_01
Normal x-ray findings of the left lower extremity in the posterior anterior view.
10.1177_1179544117702866-fig1.jpg
PMC5390922_01_10.1177_1179544117702866-fig1.jpg
fig1-1179544117702866
After a trial of conservative management with rest, ice, and nonsteroidal anti-inflammatory drugs, plain radiography of the left lower extremity was performed and was unremarkable (Figure 1).
Ultrasound image with transverse view of tibia showing increased periosteal inflammation. Increased periosteal Doppler flow is also seen (hyperemia/hypervascularity).
10.1177_1179544117702866-fig2.jpg
PMC5390922_01_10.1177_1179544117702866-fig2.jpg
fig2-1179544117702866
Ultrasound of the left tibia showed focal hyperechoic elevation of periosteum with irregularity over the left distal tibia measuring about 3 cm with a positive Doppler over the area (Figures 2 and 3).
Longitudinal view of the anterior tibia showing discontinuity of hyperechoic line representing disruption of bony cortex (green arrow) and periosteal edema (yellow arrows). On the left-hand side is a diagram showing the orientation of the probe.
10.1177_1179544117702866-fig3.jpg
PMC5390922_01_10.1177_1179544117702866-fig3.jpg
fig3-1179544117702866
Ultrasound of the left tibia showed focal hyperechoic elevation of periosteum with irregularity over the left distal tibia measuring about 3 cm with a positive Doppler over the area (Figures 2 and 3).
T2 coronal (left) image shows a lucent appearance at site of pain, and axial (right) image reveals marrow edema (green arrow) and periosteal edema (yellow arrows) of the tibia.
10.1177_1179544117702866-fig4.jpg
PMC5390922_01_10.1177_1179544117702866-fig4.jpg
fig4-1179544117702866
An MRI was ordered that confirmed periosteal reaction consistent with stress fracture over the distal tibia with no fracture line (Figure 4).
Follow-up longitudinal view at 3 weeks shows callous formation at site of injury which signifies healing.
10.1177_1179544117702866-fig5.jpg
PMC5390922_01_10.1177_1179544117702866-fig5.jpg
fig5-1179544117702866
On 3 weeks of follow-up, the patient was doing well without any significant symptoms (Figure 5).