Painful transient tibial edema

Abstract

Purpose: To report four cases of leg pain resembling transient bone marrow edema (TBME).

Materials and methods: Four women aged 51-71 years had lower leg pain that regressed over 3-13 months. All patients underwent physical examination, clinical testing, radiography, scintigraphy, and magnetic resonance (MR) imaging. One patient underwent computed tomography; two underwent biopsy.

Results: All patients had tenderness at physical examination, and one had erythema and mild swelling over part of the leg. No laboratory results suggested systemic illness or infection. All had normal radiographs and abnormal bone scans, with increased radiopharmaceutical uptake in the tibial diaphyses. MR imaging showed decreased signal intensity with T1-weighting and increased signal intensity with inversion recovery. There were also signal intensity changes consistent with edema in the surrounding soft tissues. Biopsies showed focal marrow fibrosis and new bone formation with foci of devitalized bone.

Conclusion: These cases resemble TBME but are unusual in their distribution. Whether they represent a previously undescribed clinical syndrome or a variant of TBME remains to be clarified.