Presentation
Leg swelling following chronic bone pain.
Patient Data
There is a large ill-defined sclerotic area in distal half of tibia with typical aggressive sunburst periosteal reaction along with new bone formation in soft tissue.
The inhomogeneous intramedullary lesion of distal half of tibia along with a large soft tissue component in distal third which circumferentially overlies the cortical destruction are seen. The mentioned lesion penetrates the growth plate distally and involves the tibial nerve, also. It shows postcontrast enhancement of the medullary and extraosseous components is seen.
Typical appearance of lung metastases including multiple variable-size round pulmonary nodules with ossification foci in some of them are noted.
Case Discussion
MRI is the most accurate tool for determining the tumor extension into the medullary canal and the soft tissue. Also, the epiphyseal and neurovascular involvement and skip lesions are recognized. Correlation with X-ray in nonspecific MRI findings is helpful.