Synovial hemangiomas are rare benign vascular malformations that occur in relation to the joint. It is sometimes considered a subtype of soft tissue hemangiomas.
The lesions typically present in children and young adults. Occasionally patients can have recurrent haemarthroses 8.
Patients may have pain, swelling and/or limited joint mobility.
The lesions can be cavernous, capillary or mixed.
Most lesions tend to occur around the knee 1.
Plain film findings are generally non-specific and may be seen as a soft tissue mass adjacent to the knee. Accompanying phleboliths may be present.
Typically seen as a lobulated intra-articular mass (although the lesions can be either lobulated or diffuse).
Signal characteristics include:
- T1: usually of intermediate signal 4
- markedly hyperintense background; likely from pooled blood within vascular spaces 4
- low-signal-intensity linear structures within lesion; likely from fibrous septa or vascular channels 4
- fluid-fluid levels may be present
- T1 C+: marked enhancement 5
Imaging differential considerations include:
- 1. Lee KR, Cox GG, Neff JR et-al. Cystic masses of the knee: arthrographic and CT evaluation. AJR Am J Roentgenol. 1987;148 (2): 329-34. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Barakat MJ, Hirehal K, Hopkins JR et-al. Synovial hemangioma of the knee. J Knee Surg. 2007;20 (4): 296-8. - Pubmed citation
- 3. Forrest J, Staple TW. Synovial hemangioma of the knee. Demonstration by arthrography and arteriography. Am J Roentgenol Radium Ther Nucl Med. 1971;112 (3): 512-6. Am J Roentgenol Radium Ther Nucl Med (abstract) - Pubmed citation
- 3. Sheldon PJ, Forrester DM, Learch TJ. Imaging of intraarticular masses. Radiographics. 25 (1): 105-19. doi:10.1148/rg.251045050 - Pubmed citation
- 5. De filippo M, Rovani C, Sudberry JJ et-al. Magnetic resonance imaging comparison of intra-articular cavernous synovial hemangioma and cystic synovial hyperplasia of the knee. Acta Radiol. 2006;47 (6): 581-4. - Pubmed citation
- 6. Watanabe S, Takahashi T, Fujibuchi T et-al. Synovial hemangioma of the knee joint in a 3-year-old girl. 2010;doi:10.1097/BPB.0b013e32833c31ad - Pubmed citation
- 7. Helpert C, Davies AM, Evans N et-al. Differential diagnosis of tumours and tumour-like lesions of the infrapatellar (Hoffa's) fat pad: pictorial review with an emphasis on MR imaging. Eur Radiol. 2004;14 (12): 2337-46. doi:10.1007/s00330-004-2491-1 - Pubmed citation
- 8. Carroll MB, Higgs JB. Synovial haemangioma presenting as a recurrent monoarticular haemarthrosis. Arch. Dis. Child. 2007;92 (7): 623-4. doi:10.1136/adc.2006.114066 - Free text at pubmed - Pubmed citation