Synovial haemangioma of the knee: an under recognised condition

Lopez-Oliva, Clarissa Linda Liboro; Wang, Edward H. M.; Cañal, Johanna Patricia A.

doi:10.1007/s00264-015-2930-4

Cited by 11 publications

(7 citation statements)

References 14 publications

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“…Hemangioma is a commonly used misnomer for venous malformations in many vascular anomaly publications [15,16] and was also presented as an initial diagnosis among some of our cases. Also, intra-articular venous malformations of the knee may be misleadingly designated as synovial hemangiomas in the literature [17][18][19][20]. On MRI, hemangiomas are solid lesions with uniformly high signal intensity in T2-weighted sequences, prominent feeding arteries and draining veins, and intense and homogeneous enhancement after gadolinium.…”

Section: Discussionmentioning

confidence: 99%

Intra-articular venous malformation of the knee in children: magnetic resonance imaging findings and significance of synovial involvement

et al. 2019

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Background Intra-articular venous malformations of the knee are an uncommon cause of unilateral knee pain in children. Timely diagnosis is important because lesions with intrasynovial involvement can lead to joint space hemorrhage and secondary cartilage damage. Objective To describe our tertiary center's experience of diagnostics and typical magnetic resonance imaging (MRI) findings. Materials and methods A retrospective review of all patients ≤16 years of age managed for intra-articular venous malformations of the knee at our institution between 2002 and 2018. Results Of 14 patients (8 male), the mean age at presentation was 6 years (range: 0-14 years). The most common clinical findings were unilateral knee pain (93%), joint swelling (79%), quadriceps atrophy (50%) and a limited range of motion (29%). Cutaneous manifestations were present in four patients (29%). Contrast-enhanced MRI was available in all cases. After initial MRI, a vascular anomaly etiology had been identified in 11 cases (79%), and correctly reported as a venous malformation in 6 (55%). Three patients received entirely different diagnoses (arthritis, tumor or pigmented villonodular synovitis). Three of seven patients with intrasynovial lesions had established chondropathy at diagnosis. Two patients with lesions of the suprapatellar fat pad had intrasynovial involvement that was not visualised on MRI. Conclusion Although MRI usually permits the diagnosis, clinical awareness of these lesions is important for optimal imaging, accurate interpretation and timely diagnosis. Involvement of the intrasynovial cavity carries a risk of hemarthrosis and progressive chondropathy that may be underestimated by MRI.

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Section: Discussionmentioning

confidence: 99%

Intra-articular venous malformation of the knee in children: magnetic resonance imaging findings and significance of synovial involvement

et al. 2019

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“…The clinical findings of synovial hemangioma are similar to those of D-TSGCT and hemophilic arthropathy. Both may cause sudden and non-traumatic intra-articular hemorrhage, and a delayed diagnosis can thus lead to osteoarthritis and joint function disuse ( 9 ). There are two case reports of synovial hemangioma in which >40 years passed from the onset of the disease until the final diagnosis ( 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…It was reported that large venous synovial hemangiomas showed high signal intensity on T1-WI due to slow blood flow ( 20 ). Since synovial hemangiomas are blood-rich tumors and are usually heterogeneously enhanced on gadolinium contrast, the use of which helps distinguish these tumors from cystic synovial hyperplasia ( 23 ), intra-articular hematoma, and joint effusion ( 5 , 9 , 24 , 25 ). However, it has been claimed that synovial hemangioma was correctly diagnosed preoperatively in only 22% of cases ( 9 , 14 ).…”

Section: Discussionmentioning

confidence: 99%

Radiological and pathological characteristics of synovial hemangioma of the knee

et al. 2022

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Synovial hemangioma, a rare benign tumor that occurs most frequently in the knee in children and young adults, has four histological subtypes: Venous, arteriovenous, cavernous and capillary hemangiomas. Since the clinical presentation and radiological findings of synovial hemangioma are non-specific, there is frequently a long period between the onset and the diagnosis. The cases of nine patients, pathologically diagnosed with synovial hemangioma and surgically treated, were retrospectively analyzed. All nine patients had persistent knee pain. In addition, three patients also had a swollen knee with intra-articular hemorrhage. Plain radiography revealed intra-articular phleboliths in two patients. In seven patients, T1-weighted magnetic resonance imaging showed low signal intensity with small signal voids. On T2-weighted imaging, all patients showed high signal intensity containing small signal voids. All patients underwent surgical excision; there was no postoperative recurrence after the final operation, and the knee pain had disappeared at the final follow-up. From the pathological findings, the diagnoses were venous hemangioma, cavernous hemangioma and capillary hemangioma (three patients each).

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“…Our other three cases were local sessile intra-articular SH located near the superior pole of the patella, by far the most frequent location in the anterior compartment of the knee ( 5 – 8 , 19 , 21 , 24 , 27 – 29 , 38 , 40 , 42 , 44 , 50 , 53 – 57 ), followed by the infrapatellar fat pad ( 11 , 18 , 23 , 30 , 45 , 59 ), the posterior compartment, the medial compartment ( 2 – 4 , 25 , 35 , 39 , 42 , 54 , 61 ) and the intercondylar notch ( 22 , 43 , 46 , 47 , 54 ). The three reported patients with KSH near the superior pole of the patella had the rare phenomenon of bone erosion, which was localized in the patella in two cases, a previously undescribed location for KSH bone erosion, and in the supratrochlear cortical bone in one case.…”

Section: Discussionmentioning

confidence: 99%

“…Pain is typically in the anterior aspect of the knee but can be posterior ( 14 ) or diffuse. Swelling, tenderness, effusion ( 5 , 9 – 11 , 17 , 21 , 23 , 26 , 30 , 33 , 34 , 44 , 49 , 50 , 55 ) and haemarthrosis ( 5 , 9 , 11 , 12 , 18 , 22 , 30 , 31 , 37 , 39 , 41 , 46 , 50 , 54 , 55 , 57 , 59 ) are frequent and can be recurrent. Occasionally, a palpable soft tissue mass ( 3 , 4 , 10 , 44 , 46 , 55 , 61 ) can be noted.…”

Section: Discussionmentioning

confidence: 99%

Location, Clinical Presentation, Diagnostic Algorithm and Open vs. Arthroscopic Surgery of Knee Synovial Haemangioma: A Report of Four Cases and a Literature Review

et al. 2021

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Objective: The aim was to report 4 patients with intra-articular knee synovial haemangioma (KSH) and to perform a systematic review to describe the patient characteristics, patterns of tumor location, clinical presentation, usefulness of imaging examinations, pros and cons of arthroscopic vs. open resection, and follow-up in the literature.Design: From 1996 to 2016, four patients with KSH were retrospectively reviewed. A literature search was conducted in PubMed from 2000/01 to 2020/06 using the search terms “synovial haemangioma” and “knee.” Fifty full-text articles that included a total of 92 patients were included for further discussion.Results: Four adults (20–40 years) were diagnosed with KSH. Three lesions located in the suprapatellar pouch, two eroding the patella and one the supratrochlear bone, and one in the posterior compartment. Persistent anterior knee pain was the main complain. MRI revealed a benign tumor mass in all cases except one. Open excisional biopsy and regional synovectomy were performed in three patients, and by arthroscopy of the posterior compartment in the fourth. Histological type was arteriovenous in three cases and capillary in one. A pain-free knee without recurrence was achieve in all cases except one, which was successfully reoperated. Average follow-up time was 3.5 years. A literature review showed that KSH appears most frequently in children and teenagers (64.6%) and does not differ by gender. The suprapatellar and patella-femoral joint compartment was the most frequent location (47.9%). The bony tissue of the knee was rarely affected (13.5%). Pain, swelling and haemarthrosis were frequently reported (88.2, 66.7, and 47.1%). MRI was the most commonly used imaging test (98%). Treatment consisted of regional synovectomy by open surgery or arthroscopy in 66.7 and 15.6% of cases, respectively.Conclusions: KSH should be considered in the differential diagnosis of adult patients with chronic low-intensity knee pain. MRI is the most useful exam because it establishes the location, extent and benign characteristics of the tumor. Definitive diagnosis requires histological examination. We believe excisional biopsy and regional synovectomy by arthroscopy should be the treatments of choice for intra-articular tumors, but we recommend open surgery when the lesion extends to the tendons, muscle or bone.

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Synovial haemangioma of the knee: an under recognised condition

Abstract: Synovial haemangioma is a rare but treatable condition. It should remain a differential for any patient with recurrent knee-joint symptoms.

Cited by 11 publications

References 14 publications

Intra-articular venous malformation of the knee in children: magnetic resonance imaging findings and significance of synovial involvement

Intra-articular venous malformation of the knee in children: magnetic resonance imaging findings and significance of synovial involvement

Radiological and pathological characteristics of synovial hemangioma of the knee

Location, Clinical Presentation, Diagnostic Algorithm and Open vs. Arthroscopic Surgery of Knee Synovial Haemangioma: A Report of Four Cases and a Literature Review

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