Elbow Mass in a 9-year-old Girl

Synovial Haemangioma of the Elbow: A rare paediatric case and imaging dilemma

“…The differential diagnoses of an elbow mass include synovial sarcomas, synovial haemangiomas, pigmented villonodular synovitis (PVNS), synovial chondromatosis, chronic infections of mycobacterial origin, inflammatory arthritis with pannus formation, ganglion cysts or lipoma arborescens. 7 In the present case, the lesion was unlikely to be PVNS as the condition usually demonstrates low signals on all sequences as a result of a 'blooming' phenomenon in gradient echo sequences. 11,12 Moreover, even though the patient presented with an intra-articular nodular ossified body, synovial chondromatosis usually occurs in adults rather than in young children; moreover, juvenile rheumatoid arthritis is rare before the age of 10 years.…”

“…Localised phleboliths may also be seen and are fairly specific indications of a haemangioma. 7 The precise diagnosis of synovial tumours is often difficult due to the non-specific nature of the patient's clinical symptoms and physical examination findings. The differential diagnoses of an elbow mass include synovial sarcomas, synovial haemangiomas, pigmented villonodular synovitis (PVNS), synovial chondromatosis, chronic infections of mycobacterial origin, inflammatory arthritis with pannus formation, ganglion cysts or lipoma arborescens.…”

“…The signal intensity was not suppressed upon fat saturation as extremity X-rays is usually performed in more than half of synovial haemangioma cases. 7 Radiographs commonly show a non-specific soft tissue mass. Localised phleboliths may also be seen and are fairly specific indications of a haemangioma.…”

“…11,12 Moreover, even though the patient presented with an intra-articular nodular ossified body, synovial chondromatosis usually occurs in adults rather than in young children; moreover, juvenile rheumatoid arthritis is rare before the age of 10 years. 7 A chronic mycobacterial infection was also considered improbable as there was no evidence of necrosis or marrow oedema. 7 Ganglion cysts demonstrate a low signal intensity on T1WI and a high signal intensity on T2WI; in addition, low signal intensity structures may be present within the lesion.…”

“…7 A chronic mycobacterial infection was also considered improbable as there was no evidence of necrosis or marrow oedema. 7 Ganglion cysts demonstrate a low signal intensity on T1WI and a high signal intensity on T2WI; in addition, low signal intensity structures may be present within the lesion. 13 However, this was not considered in the differential diagnosis for the current case as ganglion cysts usually have peripheral rim enhancement, which was not evident.…”