A case of intraosseous arteriovenous malformation with unusual radiological presentation of low blood flow

We report a case of intraosseous arteriovenous malformation (AVM) arising in the diaphysis of the tibia. The patient was a 15-year-old boy who presented with pain in the right lower leg for 3 years. Plain radiographs displayed honeycomb lytic lesions in the right tibial shaft, with slight expansion of the bone and cortical thinning. The lesion was isointense to the muscle on T1-weighted images, and hyperintense on T2-weighted images. An admixture of hypointense small nodular or linear areas on both T1- and T2-weighted images was present within the lesion. Post contrast fat-suppressed T1-images demonstrated a mild heterogeneous increase in signal intensity throughout the tumor. Angiographs showed only faint staining in the lesion. Curettage of the lesion was carried out, and the histological diagnosis of AVM was made. In the context of this patient's lesion, it should be noted that AVM rarely presents as an intraosseous lesion with low blood flow.