A 37-year-old-female with symptoms of severe pain of the right lower leg. A. Radiograph of the right lower leg demonstrates tiny periosteal reaction in the tibia (arrows). B. The axial T2-weighted MR image before treatment shows a tiny lesion adjacent to the tibia with cortical irregularity (arrows). C. Direct puncture phlebography reveals VM with normal veins and early venous return (Type 2). Sclerotherapy was performed with 3% polidocanol foam. D. Although the lesion decreased in size and signal intensity on MRI (arrows), she answered no change in symptoms and dissatisfaction on the questionnaire.