Synovial haemangioma of the knee: a frequently misdiagnosed lesion

Abstract

Abstract.Objective. The objective of this study was to assess the contribution of magnetic resonance (MR) imaging in the diagnosis and surgical planning of five cases of synovial haemangioma of the knee. Patients and methods. The clinical, radiological and arthroscopic features of five pathologically proven synovial haemangiomas of the knee were retrospectively reviewed. Results. A diagnostic delay, on average of 8 years, had occurred in four of the cases. Plain films were unremarkable, except for one case with arthropathy mimicking haemophilia, Arteriography, performed in three patients, was normal in one. CT, performed in three patients, showed the lesion, but the extent of the latter was better demonstrated with MR imaging. Synovial haemangiomas had a high signal intensity on T2-weighted images, without any extensive mass effect. Fibrofatty septa within the lesion were observed in three cases and muscular and/or fatty invasion in two. Arthroscopy allowed diagnosis of the lesion in two cases, but showed only nonspecific synovitis in another two. Conclusion. This study emphasizes the valuable contribution of MR imaging in the diagnosis and surgical planning of synovial haemangiomas.

Synoviales Hämangiom als seltene Ursache eines Hämarthros

“…Bei Beteiligung des Kniegelenks kommt es langfristig zu einer Quadrizepsatrophie und Zunahme der Länge des betroffenen Beins. Zusätzliche vaskuläre Veränderungen im Hautbereich über dem Gelenk können als Nävus, Hämangiom oder als Teleangiektasien auftreten (40%) [3,4,9,11,13,16,19].…”

“…Morphologisch sind synoviale Hämangiome entweder lokalisiert von meist gestielter Form oder breitbasig aufsitzend mit Infiltration in die umgebende Synovia [3,4,15].…”

“…Die bildgebende Untersuchungsmethode der Wahl ist die MRT [4,7,8,12]. Sie ermöglicht bei sehr guter Weichteildifferenzierbarkeit eine überlagerungs-freie, multiplanare Abbildung auch kleiner Tumorformationen.…”

“…Echozeit). Die zusätzliche Gadoliniumgabe im Rahmen der T 1 -Pulssequenz sowie die Verwendung T 2 -gewichteter Sequenzen führt zu einer verbesserten Abgrenzbarkeit der oft lobulierten Hämangiome; thrombosierte Gefäßareale sowie intratumoröse Septen kommen deutlicher zur Darstellung [4,7,8,12].…”

Synovial hemangioma in an adult horse

“…3 Synovial hemangiomas often become difficult to excise because they may spread throughout the entire synovium and infiltrate the surrounding muscles and fat, but often they demonstrate no significant displacement of surrounding skeletal muscles, fat, ligaments, and tendons. 3 Bone invasion is only rarely observed. 6 Regardless of their infiltrative growth, these tumors revealed no cytological features of malignancy like pleomorphism and high mitotic rate.…”