Synovial Mass Research Articles

The Tuberculous Synovitis of the Elbow: A Misunderstood Entity

We present the case of a 7-year-old child with a history of tuberculosis exposure, admitted to the pediatric surgery department due to a chronic swelling of the right elbow persisting for 3 years. Despite being afebrile, the patient experienced unspecified weight loss. Clinical examination revealed a painful fluctuating swelling of the right elbow, limited flexion, and a 12-degree valgus deformity of the ulna. Laboratory tests showed an elevated CRP level indicative of an inflammatory process. Standard radiographs exhibited soft tissue hypertrophy without bone lesions. MRI demonstrated synovial hypertrophy of the right elbow joint with adjacent bone marrow infiltration and deformation of the distal humerus. Biopsy revealed nonspecific chronic synovitis. Surgical removal of the synovial mass was performed, and histopathological examination revealed features suggestive of tuberculosis. Extension studies for tuberculosis were negative. The patient was treated with antituberculous therapy and physiotherapy, leading to the regression of symptoms. This case highlights the diagnostic utility of MRI in detecting synovial hypertrophy and bone marrow infiltration in cases of chronic elbow swelling, especially in the context of tuberculosis exposure.

Presence and size of synovial masses within the navicular bursa correlate well between magnetic resonance imaging and bursoscopy and have a guarded prognosis.

Focal hyperintense lesions within the navicular bursa emanating from the dorsal border of the deep digital flexor tendon (DDFT) can be recognised on T1-weighted magnetic resonance images (MRI) and have been attributed to lameness in horses. Removal of these lesions, also referred to as synovial masses, by navicular bursoscopy is currently recommended. To investigate the correlation between MRI and navicular bursoscopic findings. It is hypothesised that the prognosis following surgery is proportional to the size of the DDFT lesion. Retrospective analysis of clinical records. Horses undergoing standing low-field MRI and navicular bursoscopy with >1 year follow-up were included. A grading system was developed to classify the size of synovial mass(es) and lesion(s) of the DDFT on MRI and at surgery. Generalised estimating equations were used to evaluate the association between MRI findings and surgery and between outcome and severity of the tendon injury. Fifty-nine horses presenting over a 15-year period (2006-2021) fulfilled inclusion criteria. Ninety navicular bursae were examined both on MRI and endoscopically. There was strong correlation between the size of synovial masses and tendon lesions on MRI and bursoscopy (p < 0.001, OR: 25.61, 95% CI 8.71-75.29 and p < 0.001, OR: 7.34, 95% CI 2.70-19.92, respectively). Size of tendon lesion and synovial mass had no impact on prognosis (p = 0.3, OR: 1, 95% CI 1-1 and p = 0.1, OR: 1, 95% CI 1-1, respectively), which was guarded (30.5% return to previous level of exercise). Performance data for conservatively treated horses with MRI-detected synovial masses was not considered, nor was the effect of navicular bursal effusion. Horses were not randomly assigned to treatment protocols. There is good correlation between MRI and bursoscopic findings of DDFT lesions and synovial masses within the navicular bursa, with no false positives. Size of the synovial masses and DDFT lesions does not influence prognosis following navicular bursoscopy.

Lipoma Arborescens: A Rare Cause of Synovial Mass of the Knee at Pediatric Age with 10 Year Follow-up

Lipoma Arborescens: A Rare Cause of Synovial Mass of the Knee at Pediatric Age with 10 Year Follow-up

Tenosynovitis of the Flexor Digitorum and Flexor Carpi Caused by &lt;i&gt;Mycobacterium Tuberculosis&lt;/i&gt;: Case Report and Review

Background. Mycobacterial tenosynovitis of the hand and forearm is an extremely rare form of extrapulmonary tuberculosis, which can lead to permanent disability of patients.&#x0D; Case presentation. We present a rare clinical case of generalized tenosynovitis of the tendons of all hand and finger flexors of the right upper extremity caused by Mycobacterium tuberculosis (MBT). Patient complained of a lump on the palmar surface of the right hand with periodic spontaneous discharge in the form of rice grains. MRI revealed a peritendinal synovial cystic mass on the volar surface of the hand and wrist joint with the presence of multiple chondromal bodies, tendinitis and tenosynovitis of the flexor of IV and V fingers. Removal of the neoplasm, pathological tissues, and total synovectomy were performed. Intraoperative material was tested using PCR. DNA of Mycobacterium tuberculosis complex was detected.&#x0D; Conclusion. Presented case report demonstrates the importance of preoperative MRI examination in tenosynovitis of unknown etiology and the necessity of histological and bacteriological examination of intraoperative material. Transportation of obtained tissues for examination should be performed without the use of formalin in order to exclude false negative results. One should be vigilant against nonspecific infections, including Mycobacterium tuberculosis, when treating patients with immunocompromising diseases. The presence of limb neuropathy, instrumental signs of the second or the third stage of tuberculous tenosynovitis according to Kanavel classification are indications for surgical treatment.

MRI Signal Intensity–based Approach to Synovial Masses

HomeRadioGraphicsVol. 43, No. 5 PreviousNext Musculoskeletal ImagingRadioGraphics FundamentalsMRI Signal Intensity–based Approach to Synovial MassesAllison Khoo , Julie Steinberg, Jonathan Baker, Kelby NapierAllison Khoo , Julie Steinberg, Jonathan Baker, Kelby NapierAuthor AffiliationsFrom the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 1 Barnes Jewish Hospital Plaza, St Louis, MO 63110.Address correspondence to A.K. (email: [email protected]).Allison Khoo Julie SteinbergJonathan BakerKelby NapierPublished Online:Apr 13 2023https://doi.org/10.1148/rg.220081MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractBy using an MRI signal intensity–based algorithmic approach to synovial masses, radiologists can narrow the broad differential diagnosis, which includes synovial proliferative pathologic features, inflammatory and infectious arthritis and synovitis, deposition disease, trauma, vascular malformation, and rarely malignancy.Suggested Readings1. Crotty JM, Monu JU, Pope TL Jr. Synovial osteochondromatosis. Radiol Clin North Am 1996;34(2):327–342,xi. Crossref, Medline, Google Scholar2. Dhanda S, Quek ST, Bathla G, Jagmohan P. Intra-articular and peri-articular tumours and tumour mimics: what a clinician and onco-imaging radiologist should know. Malays J Med Sci 2014;21(2):4–19. Medline, Google Scholar3. Goldman AB, DiCarlo EF. Pigmented villonodular synovitis: diagnosis and differential diagnosis. Radiol Clin North Am 1988;26(6):1327–1347. Crossref, Medline, Google Scholar4. Huang GS, Lee CH, Chan WP, Chen CY, Yu JS, Resnick D. Localized Nodular Synovitis of the Knee: MR Imaging Appearance and Clinical Correlates in 21 Patients. AJR Am J Roentgenol 2003;181(2):539–543. Crossref, Medline, Google Scholar5. Kim HK, Zbojniewicz AM, Merrow AC, Cheon JE, Kim IO, Emery KH. MR findings of synovial disease in children and young adults: Part 1. Pediatr Radiol 2011;41(4):495–511; quiz 545–546. Crossref, Medline, Google Scholar6. Llauger J, Palmer J, Rosón N, Bagué S, Camins A, Cremades R. Nonseptic monoarthritis: imaging features with clinical and histopathologic correlation. RadioGraphics 2000;20(Spec No):S263–S278. Link, Google Scholar7. Mattila KA, Aronniemi J, Salminen P, Rintala RJ, Kyrklund K. Intra-articular venous malformation of the knee in children: magnetic resonance imaging findings and significance of synovial involvement. Pediatr Radiol 2020;50(4):509–515. Crossref, Medline, Google Scholar8. Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. RadioGraphics 2007;27(5):1465–1488. Link, Google Scholar9. Mutch JAJ, Doyon J, Mottard S. Intra-Articular Metastasis of Lung Carcinoma Presenting as Pigmented Villonodular Synovitis of the Knee: A Case Report. JBJS Case Connect 2013;3(2 Suppl 2):e41. Crossref, Medline, Google Scholar10. Narváez JA, Narváez J, Ortega R, De Lama E, Roca Y, Vidal N. Hypointense synovial lesions on T2-weighted images: differential diagnosis with pathologic correlation. AJR Am J Roentgenol 2003;181(3):761–769. Crossref, Medline, Google Scholar11. Narváez JA, Narváez J, De Lama E, De Albert M. MR imaging of early rheumatoid arthritis. RadioGraphics 2010;30(1):143–163; discussion 163–165. Link, Google Scholar12. Sheldon PJ, Forrester DM, Learch TJ. Imaging of intraarticular masses. RadioGraphics 2005;25(1):105–119. Link, Google Scholar13. Varma DGK, Richli WR, Charnsangavej C, Samuels BI, Kim EE, Wallace S. MR appearance of the distended iliopsoas bursa. AJR Am J Roentgenol 1991;156(5):1025–1028. Crossref, Medline, Google ScholarArticle HistoryReceived: Apr 10 2022Revision requested: May 16 2022Revision received: May 29 2022Accepted: June 8 2022Published online: Apr 13 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleMRI Signal Intensity–based Approach to Synovial MassesApr 13 2023Default Digital Object SeriesRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 43, No. 5 Slide PresentationMetrics Altmetric Score PDF download

Dynamics of Sonographic and Morphological Changes in Baker's Cyst Formation

Comparative analysis of sonographic and morphologic assessment in formation of Baker's cyst has been performed. There were 25 patients with gonarthrosis lasted 5.6 + years. In development of Bakers cyst 3 periods were defined. Each period is characterized by structural changes caused by cyst development age and gonarthrosis stage. The period has specific quantitative and qualitative patterns of cyst wall and content. Ultrasound diagnosis of cyst structural development was reliably verified by histologic data. Ultrasound assessment of synovial masses in popliteal area allows to differentiate Bakers cyst with other pathologic processes in deforming knee arthrosis of different genesis. Accurate definition of structural cyst development periods is useful for the detection of indications for cyst extirpation.

Hypoxia/reoxygenation activates the JNK pathway and accelerates synovial senescence.

Hypoxia/reoxygenation (H/R) may play an important role via senescence in the mechanism of osteoarthritis (OA) development. The synovial membrane is highly sensitive to H/R due to its oxygen consumption feature. Excessive mechanical loads and oxidative stress caused by H/R induce a senescence-associated secretory phenotype (SASP), which is related to the development of OA. The aim of the present study was to investigate the differences of SASP manifestation in synovial tissue masses between tissues from healthy controls and patients with OA. The present study used tumor necrosis factor-α (TNF-α) to pre-treat synovial tissue and fibroblast-like synoviocytes (FLS) to observe the effect of inflammatory cytokines on the synovial membrane before H/R. It was determined that H/R increased interleukin (IL)-1β and IL-6 expression levels in TNF-α-induced cell culture supernatants, increased the proportion of SA-β-gal staining, and increased the expression levels of high mobility group box 1, caspase-8, p16, p21, matrix metalloproteinase (MMP)-3 and MMP-13 in the synovium. Furthermore, H/R opened the mitochondrial permeability transition pore, caused the loss of mitochondrial membrane potential (ΔΨm) and increased the release of reactive oxygen species (ROS). Moreover, H/R caused the expansion of the mitochondrial matrix and rupture of the mitochondrial extracorporeal membrane, with a decrease in the number of cristae. In addition, H/R induced activation of the JNK signaling pathway in FLS to induce cell senescence. Thus, the present results indicated that H/R may cause inflammation and escalate synovial inflammation induced by TNF-α, which may lead to the pathogenesis of OA by increasing changes in synovial SASP and activating the JNK signaling pathway. Therefore, further studies expanding on the understanding of the pathogenesis of H/R etiology in OA are required.

EP12 Bilateral lipoma arborescens as a presenting feature of ankylosing spondylitis

Abstract Background Lipoma arborescens (LA) is a rare, slow growing lesion defined as a villous lipomatous proliferation of the synovial membrane with replacement of the synovial tissue by mature fatty cells. It usually involves the knee and can be associated with degenerative joint disease, trauma, diabetes mellitus and very occasionally with inflammatory arthritis. Diagnosis is made using MRI which shows a synovial mass that is isointense relative to fat and joint effusion. Histologically there is diffuse replacement of the subsynovial layer with mature adipocytes and infiltration of mononuclear cells. Treatment is with synovectomy and treating any underlying condition. Methods We present the first case bilateral knee LA as a presenting feature of ankylosing spondylitis. Results A 29-year-old Caucasian male presented to a knee orthopaedic surgeon with a two-year history of atraumatic bilateral knee swelling. He had a ten-year history of intermittent knee pain and stiffness which was unresponsive to non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy. Examination revealed large bilateral knee effusions with restriction of movement. Plain radiographs of his knee joints showed minor osteophytic lipping laterally on his right knee. He had an MRI of both his knees which showed bilateral joint effusions and bilateral LA. He was referred to the rheumatology team for consideration of underlying inflammatory arthritis. Further questioning revealed no history of uveitis, dactylitis, psoriasis, inflammatory bowel disease but lower back pain which was long standing. Blood tests showed rheumatoid factor, anti-CCP, anti-DsDNA, ENA were negative with ANA positive in a homogenous pattern. C-reactive protein (CRP) was only slightly raised at 5.6mg/L. Knee aspirate showed mixed inflammatory cells. Radiographs of his spine showed no syndesmophytes but sacroiliac joints showed established bilateral sacroiliitis. A diagnosis of ankylosing spondylitis with secondary LA was made. He was commenced on sulfasalazine to treat his peripheral inflammatory arthritis along with continuation of NSAID. He remained symptomatic with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of 8 and Spinal pain VAS of 9. As he fulfilled NICE guidelines for biologic use in AS, he was commenced on adalimumab 40 mg fortnightly injections and had a good response to treatment with improvement in BASDAI, pain VAS, knee swelling and normalisation of CRP. Conclusion There have been reports of LA in association with inflammatory joint disease. This is the first case of bilateral LA as a presenting feature of ankylosing spondylitis. It has been demonstrated that LA plays a role in joint inflammation and damage through tumour necrosis factor alpha (TNFα) and matrix metalloproteinase 3 (MMP3). MMP3 is known to cause joint erosion in inflammatory joint conditions such as rheumatoid arthritis and ankylosing spondylitis. It is therefore proposed that while managing LA, looking for underlying inflammatory arthritis may provide the answer. Disclosures S. Khalid None. M. Cox None. M. Kazmi None.

COMBINED TREATMENT OF SYNOVIAL CHONDROMATOSIS OF THE SHOULDER

Synovial chondromatosis is rare condition, a benign proliferation of the synovial membrane, with the possibility of forming large masses that produce cartilaginous bodies, that can either remain attached to the synovium or can detach and float in the joint, producing mechanical damage to the joint surfaces. The cartilaginous bodies can, in time, transform, ossifying and later developing bone marrow or, in very rare cases, it may suffer malignant transformation to chondrosarcoma. We present a case of a 28 years old male, with synovial chondromatosis of the left shoulder, comprising of two large synovial masses, one extended into the axillary recess and long head of biceps tendon sheath and another large mass expanded towards the anterior thoracic wall and subclavian space. We treated the case in two stages, first by open surgical procedure with resection of the synovial mass, and secondary through the arthroscopic approach, with excision of the loose bodies and synovectomy by cauterization.&#x0D; &#x0D; &#x0D; &#x0D;

Feasibility of MRI in diagnosis and characterization of intra-articular synovial masses and mass-like lesions

BackgroundClassifications of intra-articular masses are infectious granulomatous diseases, non-infectious synovial proliferative processes (synovial chondromatosis, lipoma arborescens, rheumatoid arthritis, pigmented villonodular synovitis [PVNS]), vascular malformations, deposition disorders, neoplastic, and miscellaneous conditions. The aim of this study is to correlate the results of MRI with arthroscopy in characterization of different varieties of intra-articular synovial masses and mass-like lesions. This observational prospective study was conducted between February 2018 and August 2019. We screened 1000 routine musculoskeletal MRI examination during this period, 32 of which showed intra-articular synovial masses/mass-like lesions. The selected 32 patients (20 males and 12 females) have a mean age of 49.20 ± 2.0 years; all presented with joint swelling, pain, or difficulty of movement according to the joint affected. All patients underwent arthroscopy for histopathological correlation.ResultsThe final diagnosis was synovial chondromatosis in 14 patients (43.8%), PVNS in ten patients (31.3%), and lipoma arborescens in five patients (15.6%). Synovial chondrosarcoma, synovial hematoma, and synovial ganglion cyst each in one patient (3.1%). The concordance of MRI to arthroscopy was 96.6% accuracy, 91.7% sensitivity, 99% specificity, 52.3% PPV, and 99.9% NPV.ConclusionGood correlation was observed between MRI and arthroscopy in diagnosis of intra-articular synovial masses/mass-like lesions.

Intraarticular Nodular Fasciitis in the Knee Joint with &amp;lt;i&amp;gt;USP6&amp;lt;/i&amp;gt;-Gene Rearrangement&amp;lt;br/&amp;gt;—A Case Report with Special Attention to Diagnostics of Intraarticular Lesions

Background: Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossificans. The presented case is of interest as this is a rare site of presentation of NF; so far only few single cases of intraarticular NF have been reported with documented USP6-gene rearrangement. Intraarticular neoplasias of the knee joint are rare; the most frequent being tenosynovial giant cell tumor (TSGCT). Given a nationwide annual incidence rate of 14 for the lower extremity and about 75% affecting the knee joint about 10 new cases involving the knee joint can be expected per 1 million persons/year. All other types of benign neoplasms are comparably rare while malignant intraarticular processes are extremely rare with most of them reported as single case studies. Aim: We report our case to emphasize the importance of preoperative diagnostics including the option of biopsy. Intraarticular malignant processes are extremely rare and frequently are operated on accidently with negative consequences for the patient. Tactics and techniques to treat benign processes depend on the correct pathologic diagnosis. Case presentation: The 38 year old man noticed slowly increasing swelling of his left knee joint after wakeboarding. Because of continuing discomfort 2 months later MRI diagnostic revealed, apart from retropatellar cartilage lesions, a popliteal mass compatible with a Baker cyst. The lesion of interest (later diagnosed as NF) was neither recognized by the radiologist nor the treating clinician. During the following 8 months the patient felt increasing swelling of the knee joint. The repeat MRI documented the crescent intraarticular solid synovial mass in the medial patellofemoral recess without signs of hemosiderin impregnation. A percutaneous sonographically guided 16G needle biopsy was performed. Histologically, bland myofibroblastic proliferation suggestive of nodular fasciitis (NF) was found. The next generation sequencing (NGS) demonstrated the presence of MYH9-USP6 gene fusion, confirming the diagnosis of NF. The lesion was excised under arthroscopic control. At 1 year follow-up the patient is asymptomatic. Conclusion: The case is of interest because of its rare pathology. The decision how to treat was based on pathologic biopsy diagnostics including the USP6-gene rearrangement. In view of similar presentation of the rare malignancies we also want to stress the importance of definitive diagnostics which generally are possible only through biopsy.

High-Frequency Micro-Ultrasound Imaging and Optical Topographic Imaging for Spinal Surgery: Initial Experiences

High frequency micro-ultrasound (µUS) transducers with central frequencies up to 50 MHz facilitate dynamic visualization of patient anatomy with minimal disruption of the surgical work flow. Micro-ultrasound improves spatial resolution over conventional ultrasound imaging from millimeter to micrometer, but compromises depth penetration. This trade-off is sufficient during an open surgery in which the bone is removed and theultrasound probe can be placed into the surgical cavity. By fusing µUS with pre-operative imaging and tracking the ultrasound probe intra-operatively using our optical topographic imaging technology, we can provide dynamic feedback during surgery, thus affecting clinical decision making. We present our initial experience using high-frequency µUS imaging during spinal procedures. Micro-ultrasound images were obtained in five spinal procedures. Medical rationale for use of µUS was provided for each patient. Surgical procedures were performed using the standard clinical practice with bone removal to facilitate real-time ultrasound imaging of the soft tissue. During surgery, the µUS probe was registered to the pre-operative computed tomography and magnetic resonance images. Images obtained comprised five spinal decompression surgeries (four tumor resections, one cystic synovial mass). Micro-ultrasound images obtained during spine surgery delineated exquisite detailing of the spinal anatomy including white matter and gray matter tracts and nerve roots and allowed accurate assessment of the extent of decompression/tumor resection. In conclusion, tracked µUS enables real-time imaging of the surgical cavity, conferring significant qualitative improvement over conventional ultrasound.

Pigmented Villonodular Synovitis

Pigmented villonodular synovitis is a benign proliferative synovial disorder of unknown origin that may affect the joints, bursae, or tendon sheaths, most frequently the knee. It can occur in diffuse or focal form. MR imaging is routinely used for diagnosis and follow-up in patients with pigmented villonodular synovitis. The lesions show hemosiderin deposition due to their tendency to bleed and a characteristic hypointense signal with all pulse sequences, an important diagnostic feature on MRI which helps in making the diagnosis in a young adult with monarticular involvement by synovial soft tissue mass without calcifications, with preserved joint space and normal juxtarticular bones.

It's not what it looks like: challenges in diagnosis of synovial lesions of the knee joint.

BackgroundWith the advent of MRI (Magnetic Resonance Imaging), Synovial lesions around knee are being more and more easily detected. Synovial lesions of knee present with boggy swelling, effusion, pain, and restriction of motion. Differential diagnoses of such lesions include pigmented villonodular synovitis, synovial lipoma, synovial chondromatosis, rheumatoid arthritis, synovial hemangioma, amyloid arthropathy, xanthomata and lipoma arborescens. CT and MRI often help in diagnosis of such lesions. MRI of Lipoma Arborescens has been regarded to have characteristic diagnostic appearance – it includes a synovial mass with frond-like architecture and fat signal intensity on all pulse sequences. Sometimes Lipoma Arborescens can present in conjunction with inflammatory arthritis. Synovectomy is often curative for such conditions.FindingsWe report two cases where lesions diagnosed as Lipoma Arborescens on MRI subsequently revealed to be chronic inflammatory synovitis, characterized by absence of fat infiltration in histopathological examination – refuting the original diagnosis. There was infiltration of lymphocytes and neutrophils in the synovium, suggestive of chronic inflammatory arthritis. Both of these patients required management from rheumatologist, and had relief of symptoms after use of methotrexate and hydroxychloroquine. We also report a third case, where a loose body appearing as chondral fragment on arthroscopy was subsequently diagnosed as an organized hematoma on histopathological examination.ConclusionDiagnostic pitfalls after MRI of the knee is not uncommon. For example - normal variant of meniscomeniscal ligaments have been reported as meniscal tears; motion artifacts have been falsely reported as meniscal injuries; and meniscofemoral ligament can appear as free osteochondral fragment. In most of these cases, a routine arthroscopy is enough to clear the confusion. However, as evident in the three cases described here - in some synovial lesions of knee joint, even after MRI and arthroscopic examination, histopathological confirmation may still be prudent. In spite of availability of advanced imaging technologies and high definition arthroscopy equipment, an arthroscopy surgeon still must not forget the value of histopathological examination in establishing the true nature of synovial lesions of the knee joint.

Dramatic Effect of Tofacitinib on TNF-Inhibitor Resistant Synovitis: A Case Report

A 58-year-old woman with a 2.5-year history of rheumatoid arthritis showed a pain, severe swelling, and a decreased range of motion of left knee joint. Medical therapy with 8 mg per week of oral methotrexate and 1 mg per day of tacrolimus in combination with 40 mg per 2 weeks of adalimumab failed to control the disease activity. Administration of tofacitinib achieved the successful disease control, and MRI taken 5 months after the initiation of tofacitinib showed the disappearance of synovial mass within the knee joint and the bone marrow oedema and marked reduction of the popliteal cyst. The use of tofacitinib for inadequate response to the first TNF inhibitor as a third-line DMARD showed dramatic effect on severe synovitis, and the patient could avoid the surgical intervention.

A Rare Intra-articular Pathology of Knee Lipoma Arborescens: A Report of Two Cases Managed by Arthroscopic Synovectomy: 膝關節罕見的關節內病變--樹枝狀脂肪瘤：由關節鏡滑膜切除術醫治的兩個病例報告

Lipoma arborescens is a rare intra-articular condition of unknown exact aetiology. Lipoma arborescens is one of the differential diagnoses of diffuse chronic swelling of the knee and its magnetic resonance imaging (MRI) appearance is diagnostic. We present two cases of patients with recurrent knee effusion. MRI showed a frond-like fatty synovial mass and joint effusion that suggested the likelihood of lipoma arborescens. Arthroscopic synovectomy was performed and pathology confirmed the diagnosis. There was no recurrence of symptoms after synovectomy.

Recurrent Suprapatellar Fullness and Synovial Frond-like Masses on Knee MRI.

A 50-year-old male presented with recurrent effusion around the left knee joint. There was no history of trauma to the knee or recent episode of fever. On clinical examination, suprapatellar fullness with decreased range of movement was noted. However, there was no tenderness or redness of the overlying skin. There were no complaints in other joints of the body or a similar family history. He was advised X-ray of the knee joint (anteroposterior and lateral view) which showed advanced degenerative changes in the form of reduced tibiofemoral joint space, osteophyte formation with subchondral sclerosis, and cystic changes. A large suprapatellar fullness was also seen (Fig. 1). He was advised magnetic resonance imaging (MRI) to look for any synovial or intraarticular pathology (Figs. 2, 3 and 4).

Unusual Origin of Anemia With Gluteus Red Spots

A 62-year-old woman presented with a new history of dizziness, fatigue, scant red gluteal spots and microcytic anemia of 9.9 g/dL. One year and 8 months ago, she underwent total hip replacement with successful rehabilitation. On admission, pallor of skin and red spots of gluteus region on the operation side were seen (Fig. 1). Physical examination of internal organs was unremarkable. Both hip joint motions were within normal limits. Gastroand colonoscopy did not clarify any origin of anemia. Total body CT showed synovial mass around a hip prosthesis. MRI showed metal-on-metal hip joint transplant with moderate account of synovial fluid and extensive synovial mass distributed around the joint to trochanter pushing back gluteus maximus. Reactive lymphadenopathy was seen along to iliac and groin areas. Final needle biopsy of the periarticular mass was negative for acid fast, non-acid fast bacteria and malignancy and revealed extensive inflammation. All metal implants, and metal-on-metal in particular, corrode and cause a release of metal ions. Chromium, cobalt (N < 0.25 μg/L, patient 15 μg/L) and molybdenum were implicated in development of aseptic lymphocytic vasculitis associated lesions (ALVAL) [1]. The last was proposed as a hypothesis and as a reason of anemia and rash without prosthetic failure [2]. Next step was operative revision. Synovial mass was removed and showed typical lymphocytic vasculitis inflammatory tissue (Fig. 2) [3]. The metal-on-metal prosthesis was replaced to ceramic-to-ceramic device. Rapid recovery, disappearance of vasculitis and restoration of hemoglobin (12.3 g/dL) followed. Anemia was due to chronic inflammation and the metal mediated toxiciy.

SP0022 Prevention is Better than Cure: A New Dawn for the Management of RA?

Rheumatoid Arthritis (RA) is a prototype immune-mediated inflammatory disease, in which persistent inflammation leads to joint damage, with as a consequence disability, loss of quality of life, reduced ability to...

Synovial Hemangioma Accompanied by Cruciate Ligament Injury in a Dog

We report here the clinical presentation and successful surgical management of synovial hemangioma accompanied by cruciate ligament injury in a dog. Surgical correction of cruciate ligament injury was performed after removing torn cruciate ligaments, synovial mass and masses attached to the ligaments and distal femoral articular cartilage. At 10 months, the dog has showed no evidence of recurrence in the stifle joint. Synovial hemangioma, although a seemingly rare cause of stifle joint pathology, should be considered in the differential diagnosis for cruciate ligament injury when a circumscribed intra-articular soft tissue mass is evident radiographically with cranial or caudal drawer motion. This is the first case report in a dog to describe synovial hemangioma accompanied by cruciate ligament injury.