Haemangioma of knee joint: a case report

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.

Fat Chance for Hidden Lesions: Pictorial Review of Hoffa's Fat Pad Lesions

Hoffa's fat pad (HFP) is the most commonly afflicted among all the knee fat pads. Anterior knee pain is common in various pathologies of HFP, as it is richly innervated. A potpourri of the intrinsic and extrinsic pathologies and the tumors and tumor-like conditions affect HFP, and MRI remains the fundamental modality to assess them and provide a specific diagnosis.

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

Synovial hemangioma is a rare intra articular lesion and it has several more common differentials. Therefore, our main objective is to consider the possibility of hemangioma in any intra-articular mass to prevent diagnostic delay of unnoticed or untreated hemangioma occurring within the knee joint. Ultrasound can be useful method in assessing the lesions. Surgical excision is the definitive treatment for such lesions.

Undiagnosed synovial hemangioma of the knee: a case report

BACKGROUND

Synovial hemangioma of the knee is a rare benign tumor. Very rarely, the growth of bone is affected by long-term neglect of an intra-articular tumor. Our patient had not only various clinical symptoms but also dysplasia of the femoral bone. In this report, we aimed to raise awareness to prevent various disorders arising from an unnoticed or untreated hemangioma occurring within the knee joint.

CASE PRESENTATION

Our patient was a 41-year-old Japanese man who had had occasional discomfort in the right knee since elementary school. Although he had undergone radiography at several hospitals since childhood, no issues were reported; subsequently, he consulted our hospital. We performed magnetic resonance imaging and discovered a mass. The mass was homogeneous with low intensity on T1-weighted sequences and high intensity on T2-weighted sequences adjacent to the medial femoral condyle. The shape of the medial femoral condyle presented with a concavity in axial images, with irregular margins from the patellofemoral joint to the medial femoral condyle. Moreover, by using magnetic resonance angiography, we discovered a second mass. We decided to perform open surgery to achieve complete excision. Histological examination indicated a synovial hemangioma involving a cavernous hemangioma and irregular arteriovenous connections originating from the subsynovial tissue. The patient became asymptomatic after surgery, with no recurrence for more than 4 years.

CONCLUSIONS

Synovial hemangioma is rare and difficult to diagnose in outpatient examinations because radiography has a limited diagnostic capacity. Magnetic resonance imaging and angiography are very useful. Nontreatment of intra-articular hemangiomas may lead to dysplasia of the bone and various clinical symptoms. Early complete excision may be instituted to reduce these risks of hemarthrosis.

Synovial Hemangioma of the Knee Management and Excellent Outcome 2 Years after Arthroscopic Synovectomy in a 25-year-old Male with a 20-year History

Introduction:

Synovial hemangioma is a rare condition with <200 published case reports in world literature and is frequently misdiagnosed, leading to diagnostic delay of many years. This delay is even more significant if the patient comes from a rural background with a dearth of medical facilities in the area. This case had a lag of nearly 20 years from the time of onset of symptoms and the required management which is the maximum reported for any synovial hemangioma since most of them have been found and treated in adolescents.

Case Report:

We present a case of an atypical synovial hemangioma in a 25-year-old Indian male from a poor socioeconomic background with a delay of 20 years who had both recurrent knee effusions and long-standing knee pain but kept ignoring his symptoms. It was managed by arthroscopic synovectomy. The patient reported to us after 2 years after the surgery with a painless knee and full range of movement.

Conclusion:

Synovial hemangioma mostly affects the knee joint, showing recurrent bloody effusions without a history of trauma. If there are no intermittent effusions, the diagnosis will be even more difficult. In cases of non-specific symptoms and long-standing knee pain of many years, the diagnosis of a synovial hemangioma should also be considered. In this particular case, magnetic resonance imaging was used to evaluate the patient after the plain radiographs and showed characteristic lace-like or linear patterns. Diagnostic arthroscopy and surgical excision were done in the same sitting, and biopsy was sent to the histopathology laboratory which confirmed our diagnosis. Although this patient had the disease since 20 years and presented late, he had little degeneration of cartilage at the time of arthroscopy. The functional outcome at 2-year follow-up was excellent, and he had no disability, effusion and was pain free.

Hoffa's fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice

Hoffa's (infrapatellar) fat pad (HFP) is one of the knee fat pads interposed between the joint capsule and the synovium. Located posterior to patellar tendon and anterior to the capsule, the HFP is richly innervated and, therefore, one of the sources of anterior knee pain. Repetitive local microtraumas, impingement, and surgery causing local bleeding and inflammation are the most frequent causes of HFP pain and can lead to a variety of arthrofibrotic lesions. In addition, the HFP may be secondarily involved to menisci and ligaments disorders, injuries of the patellar tendon and synovial disorders. Patients with oedema or abnormalities of the HFP on magnetic resonance imaging (MRI) are often symptomatic; however, these changes can also be seen in asymptomatic patients. Radiologists should be cautious in emphasising abnormalities of HFP since they do not always cause pain and/or difficulty in walking and, therefore, do not require therapy. Teaching Points • Hoffa's fat pad (HFP) is richly innervated and, therefore, a source of anterior knee pain. • HFP disorders are related to traumas, involvement from adjacent disorders and masses. • Patients with abnormalities of the HFP on MRI are often but not always symptomatic. • Radiologists should be cautious in emphasising abnormalities of HFP.