Presentation
Patient with history of breast cancer presenting with left leg pain.
Patient Data
Radiographs of the left tibia/fibula demonstrate focal intracortical lucency at the left anterior mid tibial diaphysis. There is a round lucency as well as a linear lucency leading into it.
MRI of the left tibia/fibula without and with IV contrast shows a dilated intraosseous vessel extending from dilated/tortuous anteromedial lower extremity vessels through the anteromedial tibial cortex, tibial medullary cavity, and subsequently the posterolateral tibial cortex. This likely represents a connection between the great saphenous vein and a tibial vein. There is no bone marrow edema or fracture. There is an overlying marker at the site of the patient's pain.
Case Discussion
An abnormal enlargement of a vein within bone, known as an intraosseous varix, is an uncommon vascular anomaly that affects long bones like the femur or tibia 1. Venous valvular insufficiency and venous thrombosis may be underlying causes (or potentially sequelae) of intraosseous varices. Clinically, regional discomfort, edema, or in more severe cases, pathological fractures, may be evident with intraosseous varices 2,3. MRI and CT can highlight the distinctive lesion inside the afflicted bone to help with the diagnosis.
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