It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee joint
Abstract Background With 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 vil...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40634-016-0039-3 |
| _version_ | 1797321349057740800 |
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| author | Kumar Kaushik Dash Piyush Vishwas Gavai Roshan Wade Amyn Rajani |
| author_facet | Kumar Kaushik Dash Piyush Vishwas Gavai Roshan Wade Amyn Rajani |
| author_sort | Kumar Kaushik Dash |
| collection | DOAJ |
| description | Abstract Background With 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. Findings We 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. Conclusion Diagnostic 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. |
| first_indexed | 2024-03-08T04:57:19Z |
| format | Article |
| id | doaj.art-44ae0abbb20b464085d02a106a026138 |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-03-08T04:57:19Z |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-44ae0abbb20b464085d02a106a0261382024-02-07T15:05:53ZengWileyJournal of Experimental Orthopaedics2197-11532016-01-0131n/an/a10.1186/s40634-016-0039-3It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee jointKumar Kaushik Dash0Piyush Vishwas Gavai1Roshan Wade2Amyn Rajani3Department of OrthopaedicsGrant Government Medical College & Sir J.J. Group of HospitalsBycullaMumbaiIndiaDepartment of OrthopaedicsGrant Government Medical College & Sir J.J. Group of HospitalsBycullaMumbaiIndiaDepartment of OrthopaedicsSeth G.S. Medical College & K.E.M. HospitalParelMumbaiIndiaDepartment of OrthopaedicsGrant Government Medical College & Sir J.J. Group of HospitalsBycullaMumbaiIndiaAbstract Background With 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. Findings We 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. Conclusion Diagnostic 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.https://doi.org/10.1186/s40634-016-0039-3Magnetic Resonance ImageLipomaMeniscal TearVillonodular SynovitisLipoma Arborescens |
| spellingShingle | Kumar Kaushik Dash Piyush Vishwas Gavai Roshan Wade Amyn Rajani It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee joint Journal of Experimental Orthopaedics Magnetic Resonance Image Lipoma Meniscal Tear Villonodular Synovitis Lipoma Arborescens |
| title | It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee joint |
| title_full | It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee joint |
| title_fullStr | It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee joint |
| title_full_unstemmed | It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee joint |
| title_short | It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee joint |
| title_sort | it s not what it looks like challenges in diagnosis of synovial lesions of the knee joint |
| topic | Magnetic Resonance Image Lipoma Meniscal Tear Villonodular Synovitis Lipoma Arborescens |
| url | https://doi.org/10.1186/s40634-016-0039-3 |
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