From the case:
Periosteal reaction from venous stasis
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This leg x-ray shows periosteal reaction around tibia and fibula. There is also soft tissue calcification medial to the tibia.
Case Discussion
This patient had chronic venous disease of the lower limbs, and the soft tissue calcification probably represents phleboliths within varicose veins.
The causes of bilaterally symmetrical smooth periosteal reaction include:
- hypertrophic osteoarthropathy
- pachydermoperiostitis
- vascular insufficiency
- thyroid acropachy
- fluorosis
Periosteal reaction due to venous stasis is typically solid and undulating and initially separated from the cortex, as in this case.
Image contributed by Dr Laughlin Dawes.
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