85-year-old male with right ankle pain, edema on MRI. Evaluate for neoplasm versus unusual insufficiency fracture There is diffuse soft tissue swelling. There is periosteal reaction along the medial malleolus and distal tibial diaphysis that is more prominent on current study than the prior study. We see no discrete fracture line, however there is slight increase in sclerosis along the anterior aspect of the distal tibial epiphysis that corresponds to the suspected insufficiency fracture seen on prior MRI.
Increase in periosteal reaction along the medial tibia and focal sclerosis along the anterior tibial epiphysis may represent an unusual insufficiency fracture as suggested on prior MRI.