Intraosseous tibia varix: Unexpected cause of leg pain: A case report

Abstract

INTRODUCTION AND IMPORTANCE: Intraosseous varicose veins are a rare cause of severe lower limb pain, often misdiagnosed due to their atypical presentation. While varicose veins commonly affect superficial vessels, intraosseous involvement remains an unusual finding with limited documentation in medical literature. This report highlights a case of sudden, severe mid-leg pain due to intraosseous venous drainage anomaly. CASE PRESENTATION: A 66-year-old male, with no known medical history, presented with an 8-month history of intermittent midshaft left leg pain. The pain began insidiously and gradually increased in frequency and intensity. On examination, there was no bluish discoloration of the medial aspect of the leg with mild swelling. There were no visible dilated veins, scars, or muscle wasting. The patient was able to walk without limping. Imaging studies, including X-ray and MRI were performed. MRI revealed findings consistent with intraosseous venous drainage abnormality. CLINICAL DISCUSSION: Intraosseous varicose veins are rarely considered in the differential diagnosis of leg pain, contributing to diagnostic delays. MRI is crucial for identifying these vascular anomalies, especially when other investigations are inconclusive. While surgical options like sclerotherapy or vessel ligation exist, conservative management can be effective for select patients. CONCLUSION: This case highlights the importance of considering intraosseous varicose veins in patients with unexplained leg pain, even in the absence of typical varicose vein symptoms. MRI is essential for diagnosis, and while conservative treatment may be initially successful, long-term surveillance and consideration of alternative interventions are necessary.