Please Help 38F Chronic leg pain not specified, Radiographs

[image: Tibial Sclerosis.jpg]
No other imaging or history….no report of previous injury.
I don’t think this looks like an old healed fracture.
I recall a case I posted some years ago that Don Resnick informed me was
Tibial Sclerosis.
I found these 2 open access articles
bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03758-5
jcorth.com/2016/07/10/intramedullary-osteosclerosis-of-the-tibial-midshaft-in-a-38-year-old-female-a-case-report-with-review-of-literature/

This is a woman….and oddly of the same age as one of the reported cases.

My questions are:
1. Is this a diagnosis of exclusion? Should I recommend CT, MRI, both?
2. Are the features so typical that I report this as Intramedullary
Osteosclerosis and recommend no follow up imaging?
3. Directed at the experts on this entity (IMOS)….why is it called
“intramedullary” when in most of the illustrated cases it actually looks
like cortical hyperostosis (see each of the attached reported cases in the
tibia)?