Intraosseous anomalous drainage: a rare case of pretibial varicose vein

Abstract

Valve failure with reflux and post-thrombotic syndrome are the factors most commonly correlated with varicose disease. Other rare etiologies can be put forward when these two main causes are ruled out. We report a case in which a young man presented chronic pain in the left tibia, varicose veins in the lower limbs and frequent occurrences of erysipelas. During investigation of the etiology of the varicose veins, radiographs and magnetic resonance imaging of the left leg were requested. These showed images suggestive of an osteolytic lesion in the tibia, but led us to the diagnosis of an intraosseous vein with anomalous drainage. This was confirmed through vascular examinations comprising Doppler venous flow measurement and phlebography. Recognition of this rare intraosseous anomaly is fundamental for proper patient management, but an intraosseous surgical approach is unnecessary.

Metaphyseal and Diaphyseal Contours: Variants and Pitfalls

“…The canals may be dilated in case of varices, vascular deformity, or adjacent tumor. 28,29 The exact vascularization of long bones and particularly of the cortices is controversial, 30,31 but micro-CT studies showed that numerous very narrow canals cross the cortex, contributing to intracortical porosity, increasing the risk and extension of microcracks. 32 Canal size, inclination, and spatial distribution (endosteal or periosteal, lateral, medial, anterior, or posterior cortex) vary in normal cases, affecting the cortex's mechanical resistance to stress.…”

Localized Pretibial Varicose Vein Caused by an Intraosseous Venous Anomaly

“…Because intraosseous venous drainage can cause venous valvular insufficiency by increasing venous pressure [6], caution is needed when evaluating pretibial varices even if there is definite truncal valvular insufficiency. Familiarity with the characteristic triad of these lesions will be helpful for the diagnosis: (1) symptom-producing pretibial varices, (2) a cortical defect in the anterior aspect of the mid-tibia, and (3) an enlarged intraosseous vein and nutrient canal [3].…”