Presentation
Left knee pain, mild tenderness, and restriction of movements were present for one year. There was no trauma or surgery in the past.
Patient Data
AP and lateral radiographs of the left knee demonstrate few well-defined intra-articular calcified lesions.
Evidence of distention of the joint by a few varying size nodules eliciting intermediate to low signal on T1 and high signal on T2 ( with areas of low signal intensity/signal void on all sequences corresponding to calcification) within the joint space with minimal background joint effusion consistent with synovial osteochondromatosis.
The bone marrow signal intensity of the imaged bones is normal with the covering cartilage's normal appearance.
Both menisci, cruciate ligaments, and collateral ligaments appear intact with no evidence of tendinosis or tear.
The patellofemoral joints, patellar cartilage, and both retinacula appear normal.
The patellar tendon, quadriceps, and Hoffa’s fat pad are normal.
The visualized muscles, vessels, and nerves are unremarkable.
OPINION:
Primary synovial osteochondromatosis.
Case Discussion
Given the patient's age and imaging of enlargement of the joint by multiple varying size nodules demonstrating intermediate to low signal on T1 and high signal on T2, within joint space with minimal background joint effusion in the absence of the severe degenerative process of the joint, primary synovial osteochondromatosis is highly suggestive rather than the secondary one, which is a related to a degenerative process.
Primary synovial chondromatosis (PSC) affects patients in the third to fifth decades of life and is more common in males. Most commonly monoarticular involvement of large joints such as knee, elbow, and shoulder.
Imaging plays a key role in the diagnosis and management as the clinical presentation is non-specific and laboratory tests do not exist.
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