Ankle joint hematoma masquerading as PVNS

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Fell and hurt ankle. Ongoing pain and swelling especially anteriorly.

Patient Data

Age: 55 years
Gender: Female

Ankle joint effusion with reactive synovitis (contrast enhancement in synovium) together with a mass in the anterior recess of the joint - heterogeneous signal intensity and subtle susceptibility artefact suggesting blood product.  Interpreted as PVNS but has no enhancement and central T1 hyperintensity indictaing methaemaglobin.

6 weeks later

mri

Follow-up scan without surgery shows almost complete resolution with a small residual joint effusion and minor residual "mass".

Case Discussion

Rather than a traumatic haemathrosis where the blood remains liquid and mixes with joint fluid, in this case the blood has clotted and formed a haemtoma acting as a "loose body" in the joint.

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