Secondary hypertrophic osteoarthropathy of the legs is a rare complication of arterial graft surgery. The syndrome is composed of arthralgias, clubbing of the toes and periostosis of the long bones and is usually associated with an infected aortic prosthesis. Often a CT-guided biopsy is performed in order to identify the graft as the primary focus. In addition to the lamellar periostosis demonstrable by conventional radiographs, a vast edema of the bone marrow and surrounding soft tissue is disclosed by MRI. Imaging promotes the early surgical reintervention.