Abstract
BackgroundIntra-articular venous malformations of the knee are an uncommon cause of unilateral knee pain in children. Timely diagnosis is important because lesions with intrasynovial involvement can lead to joint space hemorrhage and secondary cartilage damage.ObjectiveTo describe our tertiary center’s experience of diagnostics and typical magnetic resonance imaging (MRI) findings.Materials and methodsA retrospective review of all patients ≤16 years of age managed for intra-articular venous malformations of the knee at our institution between 2002 and 2018.ResultsOf 14 patients (8 male), the mean age at presentation was 6 years (range: 0–14 years). The most common clinical findings were unilateral knee pain (93%), joint swelling (79%), quadriceps atrophy (50%) and a limited range of motion (29%). Cutaneous manifestations were present in four patients (29%). Contrast-enhanced MRI was available in all cases. After initial MRI, a vascular anomaly etiology had been identified in 11 cases (79%), and correctly reported as a venous malformation in 6 (55%). Three patients received entirely different diagnoses (arthritis, tumor or pigmented villonodular synovitis). Three of seven patients with intrasynovial lesions had established chondropathy at diagnosis. Two patients with lesions of the suprapatellar fat pad had intrasynovial involvement that was not visualised on MRI.ConclusionAlthough MRI usually permits the diagnosis, clinical awareness of these lesions is important for optimal imaging, accurate interpretation and timely diagnosis. Involvement of the intrasynovial cavity carries a risk of hemarthrosis and progressive chondropathy that may be underestimated by MRI.
Highlights
Venous malformations are benign congenital, slow-flow vascular anomalies consisting of thin-walled and dilated venous channels [1, 2]
VASCERN VASCA European Reference Center, Helsinki University Hospital, Helsinki, Finland subtype of venous malformations that are an uncommon cause of knee pain in children
Diagnosis of intra-articular venous malformations of the knee is essential because lesions with intrasynovial involvement can lead to joint space hemorrhage and secondary cartilage damage, which is the most significant complication [4,5,6,7] (Fig. 1)
Summary
Venous malformations are benign congenital, slow-flow vascular anomalies consisting of thin-walled and dilated venous channels [1, 2]. Intra-articular venous malformations of the knee are a rare. VASCERN VASCA European Reference Center, Helsinki University Hospital, Helsinki, Finland subtype of venous malformations that are an uncommon cause of knee pain in children. Presenting symptoms often include nonspecific pain and joint swelling, which may be episodic, accompanied by a limited range of motion. Diagnosis of intra-articular venous malformations of the knee is essential because lesions with intrasynovial involvement can lead to joint space hemorrhage and secondary cartilage damage, which is the most significant complication [4,5,6,7] (Fig. 1). Intra-articular venous malformations of the knee are an uncommon cause of unilateral knee pain in children. Diagnosis is important because lesions with intrasynovial involvement can lead to joint space hemorrhage and secondary cartilage damage
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