Synovial osteochondromatosis

Case contributed by Fadi Aidi

Presentation

Elbow pain and swelling. No recent trauma. No fever.

Patient Data

Age: 30 years
Gender: Male
mri

There are numerous almost similar-sizes uniform intra-articular bodies of variable signal intensity, some that follow the same signal characteristics of ossified bone, and some follow characteristics similar to articular cartilage.

The joint capsule is distended with a little fluid and these numerous loose bodies.

Moderate osteoarthritic changes are noted with osteophytes formation.

The normal signal intensity of the muscle groups with no evidence of tear or mass lesion.

The viewed bone marrow appears normal with no infiltrative disease.

The findings mentioned are typical of synovial chondromatosis. 

x-ray

Multiple well-defined, rounded, loose bodies of nearly similar sizes noted confined to the elbow joint space.  Ring and arc calcifications characteristic of chondroid calcifications also noted. Moderate osteoarthritis is noted with osteophyte formation.

Case Discussion

Given the patient's age and similar sizes of intra-articular bodies, primary synovial chondromatosis is preferred over the secondary counterpart which is related to more severe degenerative changes and older age group.

Synovial osteochondromatosis is also known as Reichel syndrome which is characterized by synovial metaplasia resulting in multiple intra-articular uniform loose bodies, some of which are ossified. Secondary type results from degenerative changes of the joint which is usually seen in an older age group with fewer and larger loose bodies.

Presentation with pain and swelling. Radiologic features depend on the stage of the disease and the presence or absence of calcification of the cartilaginous nodules.

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