Intraosseous varix - tibia

Case contributed by Stan Buckens
Diagnosis almost certain


1.5 year history of pain in the tibia, excerbated by exercise (running or lifting heavy objects) and relieved by rest.

Patient Data

Age: 35 years
Gender: Male

Prominent penetrating vessel posteriorly in the tibia at the mid-diaphyseal level. 


Axial T1 and T2 at mid-tibial level showing prominent intra-osseous vein with marked flow-void phenomenon. Scan plane was chosen at approximate level of the pain, the pain was not focal enough to warrant placing a skin marker. After contrast administration an additional, more cranial scan range was acquired with a T1 Dixon weighting; the water reconstruction of which is presented here. This sequence shows the marked pulsation artifact of the intra-osseous vein. 


Post operative X-rays showing the operated upon area as a corticomedullary lucency. 

Case Discussion

Intraosseous varices are a rare cause of lower leg pain related to episodes of venous engorgement and can be debilitating. This case went on to surgical resection of the varix, after which the symptoms completely resolved. Correct diagnosis relies on an alert and well-informed radiologist working closely together with a clinician who provides the salient clinical context. 

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