Bilateral Pretibial Varices with Intraosseous Venous Drainage Anomaly: A Case Report

Abstract

We report the case of a 35-year-old male patient who complained of right anteromedial leg pain, after an intensive sport exercise. At physical examination, internal pretibial soft tissue swelling containing prominent painful varices was found. Color Doppler ultrasound, radiographic examinations, followed by CT and MR complementary investigation, were performed.

Keywords: Pretibial varices; intraosseous venous drainage; tibia.

Figure 1

Sagittal B-mode and color-Doppler ultrasound images show thrombosed varices (arrowheads) located anteriorly to the tibial shaft, coursing posteriorly through a cortical defect (arrow).

Figure 2

Lateral radiographs of the right lower leg show a small, ill-defined subcortical round lucency in the midshaft of the anterior tibial cortex and a prominent vascular groove (arrowhead).

Figures 3 and 4

Axial CT-scan images (3 and 4, respectively, right and left leg) show a serpiginous tubular structure (arrowheads) extending from the cortical defect (subjacent to the pretibial varices), coursing intramedullary as an intraosseous vein and entering a vascular groove (arrows) in the posterior cortex of the proximal tibial diaphysis. The diameter of the nutrient groove was enlarged bilaterally.

Figure 5

Axial T1-weighted with fat saturation after gadolinium injection MR imaging of the right midtibial diaphysis demonstrates pretibial varices (arrowheads), one of which travels through the anterior tibial cortex to an enlarged intraosseous vein (arrow) and prominent nutrient vascular canal.