Intraosseous venous drainage of pretibial varices

In this study, we present the case of a 74-year-old male patient who presented with a painful pretibial swelling. The patient had a history of varices of the ipsilateral leg for which he had undergone stripping and ligation. At physical examination, pretibial varices and an associated soft tissue swelling were found. Ultrasound revealed pretibial varices, one of which caused a defect on the anterior tibial cortex. Plain radiography showed a small subcortical lucency of the tibial shaft. MRI confirmed the presence of pretibial varices, one of which perforated through the anterior tibial cortex and then coursed intramedullary as an enlarged intraosseous vein. Based on these findings, the diagnosis of varices with an intraosseous venous drainage anomaly was made. The patient was subsequently successfully treated by ambulatory minisurgical phlebectomy. Knowledge and recognition of this intraosseous venous drainage anomaly, which is a rare condition, is pivotal for correct patient management. We review clinical and imaging findings, and discuss previously reported cases.