Ultrasonic diagnosis of synovial hemangioma of the knee_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Mingzhi ¹ , YANG Shunjie ² , CHEN Gang ² ,  LUO Yan ¹

1. Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Sports Medicine, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

LUO Yan, Email: luoyan@wchscu.cn

Keywords：

Synovial hemangioma; Knee joint; Ultrasonic

DOI：

10.7507/1672-2531.201907086

Video：

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Objectives To investigate the ultrasound findings of the synovial hemangioma of knee (SHK) and to evaluate its value in clinical diagnosis.Methods The ultrasonographic manifestations and clinical data of 10 patients with SHK confirmed by surgery and pathology were retrospectively analyzed and compared with MRI findings, surgery and pathological results.Results Seven cases of SHK (6 cases of diffuse type, 1 case of limited type) were assessed by ultrasound, including 1 case of vascular origin, 1 case of supraorbital sac origin, 1 case with pigmented villonodular synovitis, 1 case with thrombosis, 2 cases accompanied with bone erosion and osteophyte formation, and 3 cases with joint cavity effusion. Ultrasonic findings of SHK were as followed: 7 cases of SHK were manifestate as diffuse mass with unclear boundary, irregular shape and uneven echo mass; 5 cases had mixed-echo mass with reticular structures inside, an increased volume in erect position and positive CDFI compression test; 1 case had heterogeneous hypoechoic mass with a nodular appearance and the positive compression test; 1 case as poorly-demarcated, irregular shape, heterogeneous hyperechoic mass without obvious blood flow signals under the compression test. There were no characteristic ultrasonic findings from other 3 cases of SHK.Conclusions Diffuse SHKs have characteristic ultrasonograms. SHKs with localized and significant synovial hyperplasia have no specific ultrasonic manifestation and are easily misdiagnosed. Ultrasound is convenient, noninvasive and inexpensive. It can accurately evaluate the involvement of knee joint capsule and surrounding soft tissues. It can be used as the first line diagnostic modality for routine scanning of SHKs.

Citation： ZHANG Mingzhi, YANG Shunjie, CHEN Gang, LUO Yan. Ultrasonic diagnosis of synovial hemangioma of the knee. Chinese Journal of Evidence-Based Medicine, 2020, 20(5): 531-535. doi: 10.7507/1672-2531.201907086 Copy

1.	Vilanova JC, Barceló J, Smirniotopoulos JG, et al. Hemangioma from head to toe: MR imaging with pathologic correlation. Radiographics, 2004, 24(2): 367-385.
2.	Lopez-Oliva CL, Wang EH, Cañal JP. Synovial hemangioma of the knee: an under recognized condition. Int Orthop, 2015, 39(10): 2037-2040.
3.	Derzsi Z, Gurzu S, Jung I, et al. Arteriovenous synovial hemangioma of the popliteal fossa diagnosed in an adolescent with history of unilateral congenital clubfoot: case report and a single-institution retrospective review. Rom J Morphol Embryol, 2015, 56(2): 549-552.
4.	Murphey MD, Fairbairn KJ, Parman LM, et al. From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation. Radiographics, 1995, 15(4): 893-917.
5.	孙英彩, 崔建岭, 丁洋, 等. 滑膜血管瘤临床和影像表现. 中华放射学杂志, 2012, 46(5): 466-468.
6.	Kaya A, Imerci A, TUzlu M, et al. Extra-articular synovial hemangioma of the knee; an unusual location in the popliteal region. Anat J Clin Invest, 2014, 8(2): 82-85.
7.	Narváez JA, Narváez J, Aguilera C, et al. MR imaging of synovial tumors and tumor-like lesions. Eur Radiol, 2001, 11(12): 2549-2560.
8.	Greenspan A, Azouz EM, Matthews J 2nd, et al. Synovial hemangioma: imaging features in eight histologically proven cases, review of the literature, and differential diagnosis. Skeletal Radiol, 1995, 24(8): 583-590.
9.	Kalson NS, Gikas PD, Tirabosco R, et al. Destructive synovial hemangioma of the hip resembling pigmented villonodular synovitis. J Arthroplasty, 2011, 26(2): 339.
10.	张凌燕, 包晓丹, 唐远姣, 等. 临床及超声检查对色素沉着绒毛结节性滑膜炎及活跃期类风湿性关节炎的诊断价值. 中华医学超声杂志(电子版), 2015, 12(1): 35-39.
11.	Watanabe S, Takahashi T, Fujibuchi T, et al. Synovial hemangioma of the knee joint in a 3-year-old girl. J Pediatr Orthop B, 2010, 19(6): 515-520.
12.	Mahata M, Gayen R, Dasgupta S, et al. Synovial hemangioma of the ankle joint: a rare and unusual encounter. Inter J Bio Res, 2015, 6(9): 726.

1. Vilanova JC, Barceló J, Smirniotopoulos JG, et al. Hemangioma from head to toe: MR imaging with pathologic correlation. Radiographics, 2004, 24(2): 367-385.
2. Lopez-Oliva CL, Wang EH, Cañal JP. Synovial hemangioma of the knee: an under recognized condition. Int Orthop, 2015, 39(10): 2037-2040.
3. Derzsi Z, Gurzu S, Jung I, et al. Arteriovenous synovial hemangioma of the popliteal fossa diagnosed in an adolescent with history of unilateral congenital clubfoot: case report and a single-institution retrospective review. Rom J Morphol Embryol, 2015, 56(2): 549-552.
4. Murphey MD, Fairbairn KJ, Parman LM, et al. From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation. Radiographics, 1995, 15(4): 893-917.
5. 孙英彩, 崔建岭, 丁洋, 等. 滑膜血管瘤临床和影像表现. 中华放射学杂志, 2012, 46(5): 466-468.
6. Kaya A, Imerci A, TUzlu M, et al. Extra-articular synovial hemangioma of the knee; an unusual location in the popliteal region. Anat J Clin Invest, 2014, 8(2): 82-85.
7. Narváez JA, Narváez J, Aguilera C, et al. MR imaging of synovial tumors and tumor-like lesions. Eur Radiol, 2001, 11(12): 2549-2560.
8. Greenspan A, Azouz EM, Matthews J 2nd, et al. Synovial hemangioma: imaging features in eight histologically proven cases, review of the literature, and differential diagnosis. Skeletal Radiol, 1995, 24(8): 583-590.
9. Kalson NS, Gikas PD, Tirabosco R, et al. Destructive synovial hemangioma of the hip resembling pigmented villonodular synovitis. J Arthroplasty, 2011, 26(2): 339.
10. 张凌燕, 包晓丹, 唐远姣, 等. 临床及超声检查对色素沉着绒毛结节性滑膜炎及活跃期类风湿性关节炎的诊断价值. 中华医学超声杂志(电子版), 2015, 12(1): 35-39.
11. Watanabe S, Takahashi T, Fujibuchi T, et al. Synovial hemangioma of the knee joint in a 3-year-old girl. J Pediatr Orthop B, 2010, 19(6): 515-520.
12. Mahata M, Gayen R, Dasgupta S, et al. Synovial hemangioma of the ankle joint: a rare and unusual encounter. Inter J Bio Res, 2015, 6(9): 726.

Chinese Journal of Evidence-Based Medicine

Ultrasonic diagnosis of synovial hemangioma of the knee

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