case_images: PMC5390922_01
case_images: Normal x-ray findings of the left lower extremity in the posterior anterior view.
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case_images: After a trial of conservative management with rest, ice, and nonsteroidal anti-inflammatory drugs, plain radiography of the left lower extremity was performed and was unremarkable (Figure 1).
case_images: Ultrasound image with transverse view of tibia showing increased periosteal inflammation. Increased periosteal Doppler flow is also seen (hyperemia/hypervascularity).
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case_images: Ultrasound of the left tibia showed focal hyperechoic elevation of periosteum with irregularity over the left distal tibia measuring about 3 cm with a positive Doppler over the area (Figures 2 and 3).
case_images: Longitudinal view of the anterior tibia showing discontinuity of hyperechoic line representing disruption of bony cortex (green arrow) and periosteal edema (yellow arrows). On the left-hand side is a diagram showing the orientation of the probe.
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case_images: Ultrasound of the left tibia showed focal hyperechoic elevation of periosteum with irregularity over the left distal tibia measuring about 3 cm with a positive Doppler over the area (Figures 2 and 3).
case_images: T2 coronal (left) image shows a lucent appearance at site of pain, and axial (right) image reveals marrow edema (green arrow) and periosteal edema (yellow arrows) of the tibia.
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case_images: An MRI was ordered that confirmed periosteal reaction consistent with stress fracture over the distal tibia with no fracture line (Figure 4).
case_images: Follow-up longitudinal view at 3 weeks shows callous formation at site of injury which signifies healing.
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case_images: On 3 weeks of follow-up, the patient was doing well without any significant symptoms (Figure 5).