title: Stress-induced spiculated periosteal reaction appearing as a malignant bone tumor: a case report.
abstract: OBJECTIVE
  The aim of this study was to describe the appearance of a rare occurrence of a spiculated periosteal reaction caused by stress injury and the subsequent diagnostic assessments. A proposed mechanism for the etiology of stress-induced periosteal reactions in this case is offered.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Logan College of Chiropractic, Chesterfield, MO 63006-1065, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Haun
authors.forename: Norman W
authors.initials: NW
authors.lastname: Kettner
authors.forename: Deanna K
authors.initials: DK
authors.lastname: Bates
mesh_terms: D016512:Ankle Injuries / Q000175:diagnosis*; D001859:Bone Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010521:Periosteum / Q000473:pathology*; D011877:Radionuclide Imaging