Lower Limb Periosteal Reaction

This leg xray shows periosteal reaction around tibia and fibula (click image for arrows). There is also soft tissue calcification medial to the tibia. This patient had chronic venous disease of the lower limbs, and the soft tissue calcification probably represents phleboliths within varicose veins.
The causes of bilaterally symmetrical smooth periosteal reaction include: hypertrophic osteoarthropathy; pachydermoperiostitis; vascular insufficiency; thyroid acropachy; and flourosis. The causes of hypertrophic osteoarthropathy include: bronchogenic carcinoma; pulmonary lymphoma; lung abscess; bronchiectasis; pulmonary metastases; pleural fibroma; mesothelioma; cyanotic congenital heart disease; inflammatory bowel disease; gastrointestinal lymphoma; Whipple’s disease; coeliac disease; and primary biliary cirrhosis.
Periosteal reaction due to venous stasis is typically solid and undulating, and initially separated from the cortex, as in this case.
Reference: Chapman S and Nakielny R. Aids to Radiological Differential Diagnosis 4th edition. Saunders 2003
Credit: Dr Laughlin Dawes
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