Ultrasound-Diagnosed Tibia Stress Fracture: A Case Report

Abstract

Stress fractures are a frequent cause of lower extremity pain in athletes, and especially in runners. Plain imaging has a low sensitivity. Magnetic resonance imaging (MRI) or bone scan scintigraphy is the criterion standard, but expensive. We present the case of a young female distance runner with left shin pain. Plain radiography was unremarkable. Ultrasound showed focal hyperechoic elevation of the periosteum with irregularity over the distal tibia and increased flow on Doppler. These findings were consistent with a distal tibia stress fracture and confirmed by MRI. Examination of our case will highlight the utility of considering an ultrasound for diagnosis of tibial stress fracture.

Keywords: Stress fracture; tibia; ultrasound.

Figure 1.

Normal x-ray findings of the left lower extremity in the posterior anterior view.

Figure 2.

Ultrasound image with transverse view of tibia showing increased periosteal inflammation. Increased periosteal Doppler flow is also seen (hyperemia/hypervascularity).

Figure 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.

Figure 4.

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.

Figure 5.

Follow-up longitudinal view at 3 weeks shows callous formation at site of injury which signifies healing.