CLINICAL FEATURES: A 54-year-old female had ankle pain for 1 year. Radiographs revealed a spiculated periosteal reaction of the distal fibula. In light of the clinical history of prior breast carcinoma, the possibility of metastatic disease was entertained.
INTERVENTION AND OUTCOME: Scintigraphy and magnetic resonance imaging were used in the diagnostic evaluation of this patient. Malignancy was ruled out on the basis of the magnetic resonance imaging findings, and an etiology of a stress reaction was proposed based on the scintigraphic findings.
CONCLUSION: Stress-induced spiculated periosteal reactions are a rare occurrence. This case illustrates the role that advanced imaging plays in the assessment of a suspicious periosteal reaction.
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