Post‐traumatic chylous joint effusion

Chylous joint effusion: A rare entity that mimics septic arthritis

“…A synovial effusion is defined as chylous or chyliform when it contains a greater than 800 mg/100 ml lipid concentration. The creamy aspect results from intra-articular fat emulsification caused by lysosomal enzymes and other synovial proteins [1] . The leukocyte count at the synovial fluid is generally low, with a predominance of mononuclear cells.…”

“…The first case of a trauma-related chylous arthritis was published back in 1985 [6] . Subsequent reports from then on are scant, probably because of its rarity [1,2,7] .…”

“…In the case of high energy trauma injuries, it has been hypothesized that synovial lining disruption with subsequent leaking of subsynovial content and fat necrosis are the principal source of lipid income to the joint cavity [1,7,9] . The synovial membrane is composed of a non-sealed lining layer of 1 to 4 cell rows in close contact with the subsynovial fat.…”

Misdiagnosis of a chylous cyst as chest wall gouty tophus: A case of true pseudogout

“…Cholesterol crystals are found occasionally in synovial effusions from patients with rheumatoid arthritis (23), ankylosing spondylitis (23), bursitis (23, 24), and osteoarthritis (25). Although most cholesterol crystals are flat, rectangular, and rhomboid, and resemble broad plates with a notched corner, needle forms can also be seen (25–27), which can lead to the false diagnosis of gout. Neutral lipids can also form birefringent crystals upon drying (28), which probably explains the initial confusion about the appearance of the aspirate on the dried slide.…”

Chylous Knee Effusion: Is It Septic Arthritis? A Case Report and Review of Literature

“…12 Because synovium is only one to three cells thick, blunt trauma can disrupt this barrier and allow the subsynovial fat to leak into the joint space. Moderate-to high-energy trauma to the knee in particular can lead to necrosis of the intraarticular fat pad and subsequent chylous effusion.…”