Intra-articular Synovial Hemangioma: A Rare Cause of Knee Pain and Swelling

Undiagnosed Intra-articular Synovial Hemangioma: A Rare Cause of Knee Pain and Swelling

INTRODUCTION

Synovial hemangioma is a benign soft-tissue tumor of vascular origin. Hemangioma only accounts for 1% of all bone lesions and is mostly an incidental finding among the primary skeleton tumors. A delay in diagnosis results in joint degeneration and osteoarthritic damage because of infiltrating tumor growth.

CASE PRESENTATION

We presented a rare case of an intra-articular synovial hemangioma in a 13- year-old pediatric patient who was asymptomatic for 5 years. She attended orthopedics OPD at AIIMS, Mangalagiri. Surgical excision of the mass and partial synovectomy was done. Synovial hemangioma came out to be the diagnosis following a histologic study.

CONCLUSION

As radiography has limited diagnostic ability, synovial hemangiomas are difficult and challenging to identify on an outpatient basis. Histological examination and magnetic resonance imaging are extremely helpful. To minimize the hemarthrosis risks, early complete excision can be used as the best treatment modality.

Two Discrete Intra-articular Synovial Hemangiomas of a Knee Joint Presenting as Chronic Knee Pain

Introduction

Synovial hemangioma (SH) is a rare benign soft-tissue tumor of vascular origin. That can be extraarticular, juxta-articular, or intraarticular. The knee joint is the most common joint involved. Symptoms can be variable and diagnosis can be made using magnetic resonance imaging. Differentials can be ruled out by biopsy and the gold standard treatment is complete excision of the lesion.

Case Report

A 20-year-old male presented to outpatient clinic with a chief complaint of right-sided anterior knee pain for 2 years aggravated for 2 months. Ultrasonography and magnetic resonance imaging showed two discrete intra-articular lesions. The lesion was hypointense on T1W and hyperintense on T2W and STIR sequence that was enhancing on contrast. There were adjoining dilated vessels. With a provisional diagnosis of hemangioma, FNAC was done and then complete excision was done using a medial parapatellar arthrotomy. The patient is doing well at 1-year follow-up.

Conclusion

Knee joint SH is a rare presentation to orthopedic outdoors and has slight female predominance with pre-existing history of trauma. In the present study, both cases were of patella-femoral type (anterior and infra-patellar fat pad). For such lesions, en bloc excision is the gold standard procedure to prevent recurrence, same procedure was followed in our study, and good functional outcome was achieved.

Imaging of Lower Limb Tumors and Tumor-Like Conditions

Bone and soft tissue lesions are frequently seen in the lower limbs. Many are non-neoplastic but may mimic tumours. In this article, we discuss a practical approach for the diagnosis and management of the most common tumours and tumour-like conditions seen in the lower limbs.

Cut and cure: surgical therapy of synovitis

Surgical management for synovitis has undergone radical change in the last few years with the evolution of DMARDs and advanced Interventional Radiology techniques. Here we present areas where surgical therapy may still be the most effective option, either alone or in conjunction with non-surgical measures.

Synovial hemangioma: A rare cause of chronic knee pain

Synovial hemangioma is a rare benign vascular tumor responsible for chronic knee pain and swelling. Given its non‐specific symptoms, synovial hemangioma is often misdiagnosed. We report a case of synovial hemangioma of bilateral knee joints occurring in a young military man.

Evaluation and Management of Intra-Articular Tumors of the Knee

Intra-articular tumors of the knee are most commonly benign. Overall, this is a relatively rare clinical presentation. The differential diagnosis includes pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, synovial hemangioma, and very rarely primary sarcoma (synovial sarcoma being the most common). The clinical presentation for these conditions is usually non-specific, but radiographic and advanced imaging findings are able to differentiate some of these tumors. It is essential to obtain and send tissue specimens to pathology for histologic analysis to rule out a primary malignancy as a missed diagnosis can have grave implications on patient outcomes. This review summarized key aspects of diagnosis and treatment for these conditions.