Synovial herniation pit - growing

Case contributed by Henry Knipe

Presentation

Right hip pain.

Patient Data

Age: 65 years
Gender: Female

Cortically based lytic lesion with sclerotic margin in the right femoral neck. 

Enhancing low T1 high T2 lesion at the anterior right femoral neck-head junction with background mild cam morphology.

Gluteus minimus tendinopathy. 

Case courtesy of Dr Alex Davies. 

5 years earlier

x_ray

Cortically based lytic lesion with sclerotic margin in the right femoral neck is smaller than on the most recent x-ray. 

10 years earlier

ct

Review of a CT abdomen pelvis demonstrates a very small lucent sclerotic-rim lesion in the same location at the right femoral-head neck junction. 

Case Discussion

Synovial herniation pits are a "do not touch" lesion with a characteristic appearance that can, just on the first x-ray, be mistaken for more sinister bone lesions. What is a little atypical in this case is the growth but review of prior imaging, which was thankfully available, shows that this is a slow-growing lesion in the typical lesion.

Synovial herniation pits have been associated with cam morphology, as in this case, but a causative relationship is not certain. Growth of synovial herniation pits has been reported in the literature. 

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