Case Of the Week (COW) 30 Nov 2014
Answer:
Synovial Hemangioma.
Findings:
Soft tissue intensity lesion with restricted diffusion noted in the antero-medial aspect of the knee, abutting the distal femur. The medial patellar retinaculum is involved by the lesion. Multiple hyperdense foci are noted in the lesion (CT). Minimal cortical erosion noted along the medial femoral condyle.
Discussion:
Features suggest the possibility of the Synovial Hemangioma. Synovial haemangiomas are rare benign vascular malformations that occur in relation to the joint. It is sometimes considered a sub type of soft tissue haemangiomas. The lesions typically present in children and young adults. Occasionally patients can have recurrent haemarthroses. On T1-weighted images, synovial hemangiomas display low to intermediate signal intensity as compared to surrounding muscle and fat tissue, whereas T2-weighted images appear as high signal intensity. Thin, fibrofatty septa are characteristically seen separating the serpentine vascular components. The identification of tiny, rounded signal voids is compatible with the presence of phleboliths, which are not common Fluid-fluid levels are nonspecific but have been reported Differentials include Pigmented Villonocular Synovitis and Synovial Chondromatosis PVNS, also hemosiderin containing, characteristically shows low to intermediate (usually not high) T2 signal intensity. Synovial chondromatosis shows cartilage signal intensities with multiple loose bodies.
Contributed By:
Dr. Babu Peter, Dr. Srinivasa Raman, Dr. Suriya Kumar
Consultant Radiologists,
BIR, Anderscan Diagnostics
Answer:
Synovial Hemangioma.
Findings:
Soft tissue intensity lesion with restricted diffusion noted in the antero-medial aspect of the knee, abutting the distal femur. The medial patellar retinaculum is involved by the lesion. Multiple hyperdense foci are noted in the lesion (CT). Minimal cortical erosion noted along the medial femoral condyle.
Discussion:
Features suggest the possibility of the Synovial Hemangioma. Synovial haemangiomas are rare benign vascular malformations that occur in relation to the joint. It is sometimes considered a sub type of soft tissue haemangiomas. The lesions typically present in children and young adults. Occasionally patients can have recurrent haemarthroses. On T1-weighted images, synovial hemangiomas display low to intermediate signal intensity as compared to surrounding muscle and fat tissue, whereas T2-weighted images appear as high signal intensity. Thin, fibrofatty septa are characteristically seen separating the serpentine vascular components. The identification of tiny, rounded signal voids is compatible with the presence of phleboliths, which are not common Fluid-fluid levels are nonspecific but have been reported Differentials include Pigmented Villonocular Synovitis and Synovial Chondromatosis PVNS, also hemosiderin containing, characteristically shows low to intermediate (usually not high) T2 signal intensity. Synovial chondromatosis shows cartilage signal intensities with multiple loose bodies.
Contributed By:
Dr. Babu Peter, Dr. Srinivasa Raman, Dr. Suriya Kumar
Consultant Radiologists,
BIR, Anderscan Diagnostics