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Articular abnormalities that may mimic arthritis

Adam Greenspan
Adam Greenspan
 and 
Andrew J. Grainger
Andrew J. Grainger
   | Sep 25, 2018
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Article Category: review
Published Online: Sep 25, 2018
Page range: 212 - 223
Received: Jul 26, 2018
Accepted: Sep 06, 2018
DOI: https://doi.org/10.15557/jou.2018.0032
Keywords
© 2018 Adam Greenspan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Lateral radiograph of the elbow of a 37-year-old man with synovial osteochondromatosis shows, in addition to multiple osteochondral bodies, displaced anterior and posterior fat pads (arrows) caused by the associated joint effusion. Note the absence of features of osteoarthritis such as joint space narrowing or osteophytosis
Lateral radiograph of the elbow of a 37-year-old man with synovial osteochondromatosis shows, in addition to multiple osteochondral bodies, displaced anterior and posterior fat pads (arrows) caused by the associated joint effusion. Note the absence of features of osteoarthritis such as joint space narrowing or osteophytosis

Fig. 2.

Radiograph of the shoulder of a 34-year-old woman with synovial osteochondromatosis. Multiple osteochondral bodies spread throughout the joint and its recesses including the subscapular recess (dashed arrow) and the biceps tendon sheath (arrows). There is no evidence of osteoarthritic changes
Radiograph of the shoulder of a 34-year-old woman with synovial osteochondromatosis. Multiple osteochondral bodies spread throughout the joint and its recesses including the subscapular recess (dashed arrow) and the biceps tendon sheath (arrows). There is no evidence of osteoarthritic changes

Fig. 3.

A. Conventional axial CT of the inferior aspect of the left hip joint of a 27-year-old man with synovial osteochondromatosis shows various degrees of calcification in osteochondral bodies. B. In addition, axial CT-arthrogram reveals the presence of non-calcified chondral bodies (arrows)
A. Conventional axial CT of the inferior aspect of the left hip joint of a 27-year-old man with synovial osteochondromatosis shows various degrees of calcification in osteochondral bodies. B. In addition, axial CT-arthrogram reveals the presence of non-calcified chondral bodies (arrows)

Fig. 4.

A. Longitudinal ultrasound through the anterior aspect of the ankle joint (Tib – anterior tibia, Tal – dorsal talus) of a 31-year-old man with synovial osteochondromatosis reveals multiple calcified loose bodies (arrows), corresponding to ossified osteochondral bodies seen on the lateral radiograph (B)
A. Longitudinal ultrasound through the anterior aspect of the ankle joint (Tib – anterior tibia, Tal – dorsal talus) of a 31-year-old man with synovial osteochondromatosis reveals multiple calcified loose bodies (arrows), corresponding to ossified osteochondral bodies seen on the lateral radiograph (B)

Fig. 5.

Ultrasound of the hip (Fem – femoral head, arrowheads indicate anterior cortex of femoral neck) of the same patient as depicted in Fig. 3 shows calcified osteochondral bodies in the anterior joint line (arrows)
Ultrasound of the hip (Fem – femoral head, arrowheads indicate anterior cortex of femoral neck) of the same patient as depicted in Fig. 3 shows calcified osteochondral bodies in the anterior joint line (arrows)

Fig. 6.

A, B. Two sagittal proton-density fat-suppressed MR images of the knee of a 37-year-old man with synovial osteochondromatosis show joint effusion with several large chondral bodies in the joint (white arrows). In addition, note also numerous tiny chondral bodies layering in the supra-patellar recess (black arrows). These resemble rice bodies that can be seen in rheumatoid arthritis and tuberculous arthritis, two conditions to be considered in the differential diagnosis. C. Lateral radiograph of the knee shows the larger chondral bodies exhibiting very early calcification (white arrows). The joint effusion is apparent in the suprapatellar recess (black arrows), but the uncalcified small bodies seen on MRI are not evident
A, B. Two sagittal proton-density fat-suppressed MR images of the knee of a 37-year-old man with synovial osteochondromatosis show joint effusion with several large chondral bodies in the joint (white arrows). In addition, note also numerous tiny chondral bodies layering in the supra-patellar recess (black arrows). These resemble rice bodies that can be seen in rheumatoid arthritis and tuberculous arthritis, two conditions to be considered in the differential diagnosis. C. Lateral radiograph of the knee shows the larger chondral bodies exhibiting very early calcification (white arrows). The joint effusion is apparent in the suprapatellar recess (black arrows), but the uncalcified small bodies seen on MRI are not evident

Fig. 7.

A. Axial proton-density fat-suppressed MRI of the knee of a 28-year-old man with synovial osteochondromatosis demonstrates joint effusion along with large high T2-signal bodies in the anterior joint space (arrows). Low-signal areas within these bodies represent areas of calcification. Note also multiple small bodies, similar to those depicted in Fig. 6, in the medial joint compartment. B. Sagittal T1-weighted fat-suppressed MRI obtained after intravenous administration of gadolinium shows isointense bodies within adjacent fluid and suppressed fat. High-signal-enhanced synovium surrounds some of the bodies in the suprapatellar recess
A. Axial proton-density fat-suppressed MRI of the knee of a 28-year-old man with synovial osteochondromatosis demonstrates joint effusion along with large high T2-signal bodies in the anterior joint space (arrows). Low-signal areas within these bodies represent areas of calcification. Note also multiple small bodies, similar to those depicted in Fig. 6, in the medial joint compartment. B. Sagittal T1-weighted fat-suppressed MRI obtained after intravenous administration of gadolinium shows isointense bodies within adjacent fluid and suppressed fat. High-signal-enhanced synovium surrounds some of the bodies in the suprapatellar recess

Fig. 8.

Coronal reformatted CT image of the left shoulder of a 36-year-old man with synovial osteochondromatosis shows numerous calcified bodies within the glenohumeral joint and in the subacromial bursa. Note erosion of the humeral head (arrow)
Coronal reformatted CT image of the left shoulder of a 36-year-old man with synovial osteochondromatosis shows numerous calcified bodies within the glenohumeral joint and in the subacromial bursa. Note erosion of the humeral head (arrow)

Fig. 9.

A. Anteroposterior and B. lateral weight-bearing radiographs of the knee of a 73-year-old man with osteoarthritis and secondary osteochondromatosis shows joint space narrowing of the medial and patellofemoral compartments associated with the patellofemoral osteophytosis. Several osteochondral bodies of varying sizes are seen within the suprapatellar pouch (arrows)
A. Anteroposterior and B. lateral weight-bearing radiographs of the knee of a 73-year-old man with osteoarthritis and secondary osteochondromatosis shows joint space narrowing of the medial and patellofemoral compartments associated with the patellofemoral osteophytosis. Several osteochondral bodies of varying sizes are seen within the suprapatellar pouch (arrows)

Fig. 10.

A. Anteroposterior and B. lateral radiographs of the left elbow of a 57-year-old man with a history of several prior elbow dislocations show advanced osteoarthritis complicated by the presence of a few large but different in size intraarticular osteochondral bodies
A. Anteroposterior and B. lateral radiographs of the left elbow of a 57-year-old man with a history of several prior elbow dislocations show advanced osteoarthritis complicated by the presence of a few large but different in size intraarticular osteochondral bodies

Fig. 11.

Anteroposterior radiograph of the right elbow of a 35-year-old woman with PVNS shows dense soft tissue shadowing representing hemorrhagic joint effusion and synovitis (arrows) along with extensive well-defined subchondral erosions on both sides of the joint
Anteroposterior radiograph of the right elbow of a 35-year-old woman with PVNS shows dense soft tissue shadowing representing hemorrhagic joint effusion and synovitis (arrows) along with extensive well-defined subchondral erosions on both sides of the joint

Fig. 12.

A. Anteroposterior and B. lateral views of the left hip of a 17-year-old boy with PVNS demonstrate cyst-like erosions of the acetabulum and femoral head and neck (arrows). Note also joint space narrowing relative to the right hip
A. Anteroposterior and B. lateral views of the left hip of a 17-year-old boy with PVNS demonstrate cyst-like erosions of the acetabulum and femoral head and neck (arrows). Note also joint space narrowing relative to the right hip

Fig. 13.

A. Lateral radiograph of the knee of a 25-year-old man with PVNS shows what appears to be suprapatellar joint effusion (arrows). However, the density of the fluid is increased, and there is some lobulation present. B Contrast arthrogram of the knee shows lobulated filling defects in the suprapatellar bursa, representing lumpy synovial masses
A. Lateral radiograph of the knee of a 25-year-old man with PVNS shows what appears to be suprapatellar joint effusion (arrows). However, the density of the fluid is increased, and there is some lobulation present. B Contrast arthrogram of the knee shows lobulated filling defects in the suprapatellar bursa, representing lumpy synovial masses

Fig. 14.

Longitudinal ultrasound image of the ankle of a 26-year-old woman with PVNS demonstrates an intraarticular soft tissue mass within the anterior aspect of the joint showing low reflectivity (arrows)
Longitudinal ultrasound image of the ankle of a 26-year-old woman with PVNS demonstrates an intraarticular soft tissue mass within the anterior aspect of the joint showing low reflectivity (arrows)

Fig. 15.

A 57-year-old man presented with a thigh mass that on the biopsy was diagnosed as PVNS. A. Axial T1-weighted, B. axial T2-weighted fat-suppressed, and C. sagittal T2-weighed fat-suppressed MR images show the mass to be arising from the suprapatellar recess and showing intermediate T1 signal. The mass shows typical signal characteristics on the T2-weighted images, appearing intermediate-to-low signal with foci of high signal representing fluid and synovium (arrows). The sagittal image also reveals joint effusion (*)
A 57-year-old man presented with a thigh mass that on the biopsy was diagnosed as PVNS. A. Axial T1-weighted, B. axial T2-weighted fat-suppressed, and C. sagittal T2-weighed fat-suppressed MR images show the mass to be arising from the suprapatellar recess and showing intermediate T1 signal. The mass shows typical signal characteristics on the T2-weighted images, appearing intermediate-to-low signal with foci of high signal representing fluid and synovium (arrows). The sagittal image also reveals joint effusion (*)

Fig. 16.

A Longitudinal ultrasound of the knee of a 17-year-old girl who presented with a history of recurrent hemarthrosis and palpable mass over anterolateral aspect of the knee shows a heterogeneous predominantly hyporeflective mass alongside the lateral femoral metaphysis (arrows). B. Color Doppler examination demonstrates flow in the tortuous vessels within the lesson. The apparent “flow” within the femur (arrows) is caused by reverberation artefact
A Longitudinal ultrasound of the knee of a 17-year-old girl who presented with a history of recurrent hemarthrosis and palpable mass over anterolateral aspect of the knee shows a heterogeneous predominantly hyporeflective mass alongside the lateral femoral metaphysis (arrows). B. Color Doppler examination demonstrates flow in the tortuous vessels within the lesson. The apparent “flow” within the femur (arrows) is caused by reverberation artefact

Fig. 17.

Angiogram performed in the patient depicted in Fig. 16 at the time of direct puncture of the lesion and injection of contrast during sclerotherapy demonstrates disorganized vessels within the hemangioma
Angiogram performed in the patient depicted in Fig. 16 at the time of direct puncture of the lesion and injection of contrast during sclerotherapy demonstrates disorganized vessels within the hemangioma

Fig. 18.

A. Coronal proton-density fat-suppressed MRI of the knee of the same patient depicted in Fig. 16 shows the mass exhibiting high signal intensity with some internal low-signal separation and striation (long arrows). Note also a low signal change in the joint (short arrows) due to hemosiderinladen synovium from recurrent hemarthroses. B. Sagittal gradient-echo scout image shows a typical blooming artefact from the joint due to a susceptibility artefact from the hemosiderin demonstrated on the T2* image
A. Coronal proton-density fat-suppressed MRI of the knee of the same patient depicted in Fig. 16 shows the mass exhibiting high signal intensity with some internal low-signal separation and striation (long arrows). Note also a low signal change in the joint (short arrows) due to hemosiderinladen synovium from recurrent hemarthroses. B. Sagittal gradient-echo scout image shows a typical blooming artefact from the joint due to a susceptibility artefact from the hemosiderin demonstrated on the T2* image

Fig. 19.

A. Sagittal T1-weighted MR image of the knee of a 9-year-old boy with synovial hemangioma shows isointense with muscle masses within the suprapatellar bursa and infrapatellar Hoffa fat pad. B. Sagittal T2-weighted fat-suppressed MR image shows the masses becoming very bright. The fluid-fluid levels seen in the popliteal region (arrowheads) are typical for the cavernous type of the lesion
A. Sagittal T1-weighted MR image of the knee of a 9-year-old boy with synovial hemangioma shows isointense with muscle masses within the suprapatellar bursa and infrapatellar Hoffa fat pad. B. Sagittal T2-weighted fat-suppressed MR image shows the masses becoming very bright. The fluid-fluid levels seen in the popliteal region (arrowheads) are typical for the cavernous type of the lesion

Fig. 20.

A. Coronal T1-weighted MR image of the right knee of a 42-year-old woman who presented with painless swelling of the knee shows large joint effusion with high signal intensity frond-like synovitis due to fat deposition within the synovium. B. Axial proton-density fat-suppressed MRI shows the fatty synovial proliferation as dark (due to the fat suppressed sequence) against the high-signal fluid within the joint; findings characteristic of lipoma arborescens
A. Coronal T1-weighted MR image of the right knee of a 42-year-old woman who presented with painless swelling of the knee shows large joint effusion with high signal intensity frond-like synovitis due to fat deposition within the synovium. B. Axial proton-density fat-suppressed MRI shows the fatty synovial proliferation as dark (due to the fat suppressed sequence) against the high-signal fluid within the joint; findings characteristic of lipoma arborescens

Fig. 21.

Longitudinal ultrasound through the suprapatellar recess of the right knee of the patient depicted in Fig. 20, shows hyperechoic fronds of lipid-laden synovium (arrows) surrounded by the anechoic joint fluid
Longitudinal ultrasound through the suprapatellar recess of the right knee of the patient depicted in Fig. 20, shows hyperechoic fronds of lipid-laden synovium (arrows) surrounded by the anechoic joint fluid
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