Presentation
Acute onset leg pain, present for 2 weeks.
Patient Data
Age: 20 years
Gender: Male
From the case:
Stress fracture with gray cortex sign
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Cortical thickening at the lateral aspect of the distal fibular diaphysis that is hypodense to the surrounding cortex.
From the case:
Stress fracture with gray cortex sign
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Annotated images showing the site of decreased density of the cortex, where there is also stress-related cortical thickening (white arrow). Note the normal density cortex adjacent to this (open arrow).
Case Discussion
Early stress fracture sites often show diminished cortical density in the affected region prior to the cortical thickening and sclerosis that will be seen with more chronic stress-related injury. This is presumably related to osteoclastic resorption from hyperemia.