Presentation
History of psoriasis and intermittently swollen knees and interphalangeal joints. Presents with clinically large knee effusions.
Patient Data
Large lucencies in the lateral femur condyle and in the medial tibia epicondyle.
Reactive osteophytes.
Large hyperdense knee effusion.
- Axial T1 - large effusion with frond-like synovia containing fat covered by synovial tissue
- Sagittal T1 - similar moderate severity changes in the posterior aspect of the knee joint, proximal to the posterior cruciate ligament
- Sagittal PD fat sat - relatively large fluid containing erosions in the lateral femur condyle and the medial tibia epicondyle, corresponding to lytic lesions on radiograph
- Axial/coronal T1 C+ fat sat
- contrast enhancement of the synovia, but not the overlying fat
- along both the medial and lateral femur condyles there is thick, contrast enhancing synovia
- contrast enhancing synovia in the bone erosions
Case Discussion
Patient with psoriasis and a history of swelling interphalangeal joints and knees.
On X-ray images there are erosive bone changes and a hyperdense knee effusion.
On MRI, evaluation of the soft tissue reveals a large amount of intraarticular fluid, hypertrophied enhancing synovia, and frond-like synovia containing fat. Evaluation of the bone shows bone erosions and osteophytes.
The findings overall suggest diagnosis of chronic synovitis with lipoma arborescens.
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