case_images: PMC3180721_01
case_images: Radiograph of bilateral legs anteroposterior view shows cortical thickening of the diaphyses of both tibiae, left more than right
case_images: IJNM-26-36-g001.jpg
case_images: PMC3180721_01_IJNM-26-36-g001.jpg
case_images: F1
case_images: She underwent a radiograph of both legs which showed cortical thickening of the diaphyses of both tibiae [Figure 1].
case_images: (a and b) Anterior and posterior delayed phase images of 99mTc-MDP bone scan showing irregular increased uptake in the diaphyseal region of both tibiae; rest of the skeleton shows physiologic uptake. (c and d) Anterior and posterior pool phase images of 99mTc-MDP bone scan show increased uptake in the bilateral mid-calf region of both legs
case_images: IJNM-26-36-g002.jpg
case_images: PMC3180721_01_IJNM-26-36-g002.jpg
case_images: F2
case_images: A three-phase 99mTc-MDP bone scan [Figure 2] showed intense irregular uptake in the diaphyseal region of both tibiae in delayed static images.
case_images: Short tau inversion recovery coronal (a) and axial (b) images show cortical thickening (arrows) with bone marrow edema in bilateral tibial diaphysis. Also noted is minimal adjacent soft tissue edema. T1W axial (c) image shows diffuse cortical thickening better
case_images: IJNM-26-36-g003.jpg
case_images: PMC3180721_01_IJNM-26-36-g003.jpg
case_images: F3
case_images: The patient further underwent magnetic resonance imaging (MRI) which revealed cortical thickening with bone marrow edema in bilateral tibial diaphysis along with minimal adjacent soft tissue edema [Figure 3].
case_images: Photomicrographs of tibial biopsy specimen stained with H and E at low power (4x) show predominantly dense lamellar bone with irregular sized and spaced haversian systems. The bony lamellae are thick, sclerotic with few osteocytes. Photomicrographs at higher magnification (40x) demonstrate dense lamellar bone with fragments of normal cortical bone. The haversian canals are variable in caliber, irregular spaced and are increased in number
case_images: IJNM-26-36-g004.jpg
case_images: PMC3180721_01_IJNM-26-36-g004.jpg
case_images: F4
case_images: The patient then underwent a tibial biopsy which revealed predominantly dense lamellar bone with irregular sized and spaced haversian systems [Figure 4].