Ankle joint hematoma masquerading as tenosoynvial giant cell tumor

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Fell and hurt ankle. Ongoing pain and swelling especially anteriorly.

Patient Data

Age: 55 years
Gender: Female

Ankle joint effusion with reactive synovitis (contrast enhancement in synovium) together with a mass in the anterior recess of the joint - heterogeneous signal intensity and subtle susceptibility artefact suggesting blood product. 

This abnormality was interpreted as PVNS (now known as tenosynovial giant cell tumor) but has no enhancement and central T1 hyperintensity indictaing methaemaglobin.

Follow-up scan without surgery shows almost complete resolution with a small residual joint effusion and minor residual "mass".

Case Discussion

Rather than a traumatic haemathrosis where the blood remains liquid and mixes with joint fluid, in this case the blood has clotted and formed a haemtoma acting as a "loose body" in the joint.

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