OWL: OCOSH Classification/Joint Diseases/Haemarthrosis

2003 Hypointense Synovial Lesions on T2-Weighted MRI Images

Narv�ez et al — 2009-01-21 00:15:09 GMT

AJR 2003; 181:761-769 Hypointense Synovial Lesions on T2-Weighted Images: Differential Diagnosis with Pathologic Correlation Jos� A. Narv�ez, Javier Narv�ez, Ra�l Ortega1, Eugenia De Lama1, Yolanda Roca1 and Noem� Vidal
Synovial tissue that lines joint cavities, bursae, and tendinous sheaths is generally too thin to be shown on MRI. However, as synovial tissue thickens because of diverse abnormal conditions, it may become visible on MRI. Signal intensity is a feature of paramount importance in the MRI assessment of these synovial lesions.
Contents
Pigmented Villonodular Synovitis Giant Cell Tumor Hemophilic Arthropathy Dialysis-Related Amyloid Synovial Chondromatosis Long-Standing Rheumatoid Chronic Tophaceous Gout Siderotic Synovitis

A bleeding pseudoaneurysm of the lateral genicular artery after total knee arthroplasty

Pritsch et al — 2009-10-16 00:15:09 GMT

4 weeks after surgery, the patient started to complain of increasing pain and gradual swelling of his operated knee. He presented to the emergency room due to agonizing knee pain 2 weeks later. His left knee was very swollen, especially on the anterolateral side. It was warm and tender and any passive or active motion aggravated the pain.
An angiographic examination was performed because of suspected recurrent bleeding, and a bleeding pseudoaneurysm of the superior lateral genicular artery was demonstrated (Figure 1A). Using a microcatheter, a super-selective catheterization of the lateral genicular artery was performed and the artery was embolized by means of 3-mm coils (Figure 1B). During a second arthroscopy several hours after the embolization, blood clots were drained and the prosthetic joint was lavaged. The patient experienced instant relief and there was a major improvement in the extent of pain, swelling and range of motion.
A bleeding pseudoaneurysm of the lateral genicular artery after total knee arthroplasty--a case report. Pritsch T, Parnes N, Menachem A. Acta Orthop. 2005 Feb;76(1):138-40 full text

A case of intra-articular fracture of the knee joint with three layers within lipohemarthrosis by ultrasonography and computed tomography

Yabe et al — 2009-10-16 00:15:09 GMT

We report a case of intra-articular fracture of the knee joint showing three layers within lipohemarthrosis. Sagittal ultrasonography showed three layers (double fluid-fluid level): a superior hyperechoic layer of fat, an intermediate anechoic layer of serum, and an inferior hypoechoic layer of red blood cells. Horizontal computed tomography imaging demonstrated the same three layers. This is the first case of lipohemarthrosis in which three layers of joint effusion were confirmed by both ultrasonography and computed tomography.
A case of intra-articular fracture of the knee joint with three layers within lipohemarthrosis by ultrasonography and computed tomography. Yabe M, Suzuki M, Hiraoka N, Nakada K, Tsuda T. Radiat Med. 2000 Sep-Oct;18(5):319-21.

Acute haemarthrosis of the knee in athletes

Maffulli et al — 2009-10-16 00:15:09 GMT

We made a prospective arthroscopic study of 106 skeletally mature male sportsmen with an average age of 28.35 years (16.8 to 44) who presented with an acute haemarthrosis of the knee due to sporting activities. We excluded those with patellar dislocations, radiographic bone injuries, extra-articular ligamentous lesions or a previous injury to the same joint. The anterior cruciate ligament (ACL) was intact in 35 patients, partially disrupted in 28 and completely ruptured in 43. In the patients with an ACL lesion, associated injuries included meniscal tears (17 patients), cartilaginous loose bodies (6), and minimal osteochondral fractures of the patella (2), the tibial plateau (3) or the femoral condyle (9). We found no age-related trend in the pattern of ACL injuries. Isolated injuries included one small osteochondral fracture of the patella, and one partial and one total disruption of the posterior cruciate ligament. Three patients had cartilaginous loose bodies, and no injury was detected in five. Acute traumatic haemarthrosis indicates a serious ligament injury until proved otherwise, and arthroscopy is needed to complement careful history and clinical examination. All cases with a tense effusion developing within 12 hours of injury should have an aspiration. If haemarthrosis is confirmed, urgent admission and arthroscopy are indicated.
Acute haemarthrosis of the knee in athletes. A prospective study of 106 cases. Maffulli N, Binfield PM, King JB, Good CJ. J Bone Joint Surg Br. 1993 Nov;75(6):945-9.

Acute Knee Effusions - A Systematic Approach to Diagnosis

M W Johnson — 2009-10-16 00:15:09 GMT

Knee effusions may be the result of trauma, overuse or systemic disease. An understanding of knee pathoanatomy is an invaluable part of making the correct diagnosis and formulating a treatment plan. Taking a thorough medical history is the key component of the evaluation. The most common traumatic causes of knee effusion are ligamentous, osseous and meniscal injuries, and overuse syndromes. Atraumatic etiologies include arthritis, infection, crystal deposition and tumor. It is essential to compare the affected knee with the unaffected knee. Systematic physical examination of the knee, using specific maneuvers, and the appropriate use of diagnostic imaging studies and arthrocentesis establish the correct diagnosis and treatment.
Acute Knee Effusions: A Systematic Approach to Diagnosis MICHAEL W. JOHNSON, MAJ, MC, USA American Family Physician� > Vol. 61/No. 8 (April 15, 2000)

Acute traumatic hemarthrosis of the knee

Sarimo et al — 2009-10-16 00:15:09 GMT

Distortions and contusions of the knee are common. Fairly often they will result in hemarthrosis. The purpose of this study was to evaluate the findings in patients with acute traumatic hemarthrosis of the knee and based on these findings estimate the necessity of acute arthroscopic examination.
CONCLUSIONS: Based on our findings we believe that routine arthroscopic examination is not necessary in patients with acute traumatic hemarthrosis of the knee. In our opinion the patient should be examined and followed by an orthopedic surgeon and if a lesion requiring operative treatment is diagnosed or suspected, an arthroscopic examination should be scheduled. The timing of the procedure should be such that all possible lesions encountered can be treated in the same operation.
Acute traumatic hemarthrosis of the knee. Is routine arthroscopic examination necessary? A study of 320 consecutive patients. Sarimo J, Rantanen J, Heikkil� J, Helttula I, Hiltunen A, Orava S. Scand J Surg. 2002;91(4):361-4.

An acutely painful elbow as a first presentation of von Willebrand's disease

Poncia HD, Ryan J. — 2009-10-16 00:15:09 GMT

A 26 year old woman presented to the accident and emergency department with a painful right elbow. There had been no history of trauma. Clinical examination suggested an effusion, which was confirmed on radiological examination. Her elbow was aspirated and revealed a haemarthrosis. Subsequent investigations revealed a diagnosis of von Willebrand's disease (vWD). A spontaneously occurring effusion of the elbow may be due to a haemarthrosis. Aspiration of blood in the absence of trauma may lead to a diagnosis of an occult coagulopathy in addition to relieving pain. The diagnosis and treatment of vWD is discussed.
An acutely painful elbow as a first presentation of von Willebrand's disease. Poncia HD, Ryan J. J Accid Emerg Med. 1999 Mar;16(2):153-4.

Aspiration of acute traumatic knee haemarthrosis

Wallman P, Carley S. — 2009-10-16 00:15:09 GMT

A short cut review was carried out to establish whether aspiration of a traumatic knee haemarthrosis improved the patient's symptoms. Altogether 267 papers were found using the reported search, of which none answered the question posed. Further research is needed in this area.
Aspiration of acute traumatic knee haemarthrosis. Wallman P, Carley S. Emerg Med J. 2002 Jan;19(1):50. Full text available

Differential Diagnosis of Knee Hemarthrosis Wheeless

C.R.Wheeless — 2002-02-04 00:15:09 GMT

- non-bloody effusion suggests an irrative synovitis that may be caused by degenerative meniscus or a chronic process with no super imposed acute injury;
- absence of hemarthrosis is not indication of less severe ligament injury, since severe disruptions often cause only minimal joint distention;
- disruption may be so complete that blood escapes into soft tissues and the popliteal space rather than distending the joint;
- tense hemarthosis of effusion may prevent full extension of the knee joint and should be evacuated;
- aspirate should always be examined for fat globules which may indicated osteochondral fracture or tibial plateau fracture;
Wheeless' Textbook of Orthopaedics

Effusion of the hips in a patient with tetraplegia

Kupfer et al — 2009-10-16 00:15:09 GMT

A 19-year-old man with a complete cervical spinal cord injury was found to have bilateral hip effusions. Joint aspiration yielded a right sterile hydroarthrosis and a left sterile hemarthrosis.
CONCLUSION: This case indicates that hip effusion may be a similar, less-common occurrence than knee effusion in patients with spinal cord injury.
Effusion of the hips in a patient with tetraplegia. Kupfer M, Dholakia M, O'Neill BJ. J Spinal Cord Med. 2006;29(2):160-2.

Fluid-fluid levels in injured knees

Lugo-Olivieri — 2009-10-16 00:15:09 GMT

PURPOSE: To determine if fluid-fluid levels on horizontal-beam radiographs of posttraumatic knee joints always represent lipohemarthrosis.
CONCLUSION: Single fluid-fluid levels in posttraumatic knee joints do not necessarily represent a lipohemarthrosis. Double fluid-fluid levels are a more specific finding.
Fluid-fluid levels in injured knees: do they always represent lipohemarthrosis? Lugo-Olivieri CH, Scott WW Jr, Zerhouni EA. Radiology. 1996 Feb;198(2):499-502.

Hemarthrosis - an unusual complication of type 1 neurofibromatosis

Richette et al — 2009-10-16 00:15:09 GMT

Type 1 neurofibromatosis is one of the most common autosomal-dominant disorders and often includes orthopedic manifestations. We report the case of a 48-year-old woman with hemarthrosis caused by a popliteal cyst infiltrated by a diffuse neurofibroma associated with angiodysplasia. Surgical resection of this tumor was followed by postoperative hemorrhagic complications
Hemarthrosis: an unusual complication of type 1 neurofibromatosis. Richette P, Claudepierre P, Voisin MC, Le Mouel S, Wolkenstein P, Rahmouni A, Chevalier X. Arthritis Rheum. 2001 Sep;44(9):2134-7. Full text

Hemarthrosis and scurvy

Haslock I. — 2009-10-16 00:15:09 GMT

Letter commenting on an article indicating haemarthrosis may be the presenting complaint of scurvy. All cases had poor diets typical of elderly people hampered by joint disease. It is suggested that this association is underdiagnosied.
Hemarthrosis and scurvy. Haslock I. J Rheumatol. 2002 Aug;29(8):1808.

Magnetic resonance imaging in acute knee haemarthrosis

Mukerjee A. — 2009-10-16 00:15:09 GMT

Arthroscopy was used as a gold standard in both selected studies. MRI lacks both the sensitivity required for a SnOut and specificity required for a SpIn on this evidence. The evidence only applies to the conditions stated (haemarthrosis and investigation within one week) and different results might be found at different times.
Clinical bottom line The evidence does not support early use of MRI scanning in acute knee haemarthrosis.
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Magnetic resonance imaging in acute knee haemarthrosis. Mukerjee A. J Accid Emerg Med. 1999 May;16(3):216-7

Recurrent hemarthrosis of the knee mimicking pigmented villonodular synovitis

Keren et al — 2009-10-16 00:15:09 GMT

Case presentation of an 84 yr old man with recurrent haemarthrosis of the knee. He was suspected of having PVS. A total knee replacement operation was undertaken and biopsy of the synovium showed severe chronic synovitis but not PVS. The case is discussed in relation to the investigation and management of PVS and the causes of hemarthrosis.
Recurrent hemarthrosis of the knee mimicking pigmented villonodular synovitis. Keren T, Shahmurov M, Hendel D. Isr Med Assoc J. 2005 Jan;7(1):50-1. Full text