Stress-Induced Spiculated Periosteal Reaction Appearing as a Malignant Bone Tumor: A Case Report

The AP radiograph of the ankle (A) shows a spiculated periosteal reaction on the medial margin of the metadiaphyseal region of the distal fibula (arrows). Close-up view showing the spiculation and irregularity of the periosteum (B).

A T1-weighted gadolinium-enhanced axial magnetic resonance image through the distal leg (A) shows enhancement of the periosteum (arrow) at the insertion of the IOM. T2-weighted magnetic resonance axial image (B) shows high signal intensity in the same location, which is indicative of inflammation. The bone marrow and cortex are uninvolved.

Proton-density transverse magnetic resonance image through the level of the talus (A) shows inhomogeneous signal intensity (arrowhead) in the PTT, which is indicative of tendinopathy. Also noted was an increase in fluid in the tendon sheath (arrow), which is indicative of tenosynovitis. T2-weighted transverse magnetic resonance image through the level of the talus (B) shows high signal intensity within the PTT (arrowhead), which is suggestive of a partial tear. An excessive amount of high signal intensity fluid is also observed within the tendon sheath surrounding the PTT indicating tenosynovitis.