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Foreign body induced knee synovitis

Case contributed by: Dr Maulik S Patel

Presentation:

14 yrs. boy with a history of wood splinter injury to knee about one year. 1 surgery and 2 aspirations done so far. MR showing synovitis. Referred for USG to look for any residual wood splinter - foreign body.

Patient Data:

Age: about 10 - 15 yrs.
Gender: Male
Race: Indian/Pakistani
Modality: X-ray

XRay - Prominent supra and infrapatellar soft tissue.

Modality: Ultrasound

Synovitis in suprapatellar region with a foreign body ( 5 mm ) embedded within synovium. A second foreign body ( 10 mm ) posterior to posterior cruciate ligament. A third foreign body ( 15 mm ) posterior to calf vessels.

Foreign body granuma is noted here; abutting vessels. No thrombosis was present.

Popliteal cyst as well as extra-articular collection.  Reactive node in popliteal fossa adjacent to popliteal vessels.

 

Case Discussion:

Fragmentation and migration are major casues for false nevative ultrasound when you are looking for this kind of foreign body.  

Presence of gas in soft tissue can result in false negative or false positive ultrasound finding.

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