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Synovial hemangioma of the knee.

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647
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Synovial Hemangioma of the Knee
Sir:
Synovial hemangioma is a rare joint lesion
which, among the 96 reported cases,1-15 recurred
most frequently in the knee. The patient i s usually
an adolescent or young adult who complains of
recurrent, transient swelling of the joint, causing
painful limitation of motion, limp, and diffuse
joint tenderness. Roentgenograms are normal, but
joint aspiration, if performed, produces heavily
blood-stained synovial fluid. Surgery has been
regularly required for definitive diagnosis but that
this can be reached preoperatively is demonstrated
by the following case report.
Case report. MIS. H.H., age 37, gave a long
history of repeated episodes of painful swelling of
the right knee. The first attack consisted of sudden
popliteal pain with rapidly progressive diffuse
joint swelling which lasted for 2 days. During the
ensuing 10 years she experienced 20 to 30 similar
episodes, all unrelated to trauma but of progressively longer duration. The most recent episode
had lasted for a month. Between attacks, examination showed the knee was entirely normal. On
examination, there was a full range of active and
passive knee flexion with normal muscle power and
no instability. The joint contained a moderate
amount of fluid, and there was no crepitus. Manipulative tests for meniscus injury were negative.
Aspiration of the affected knee, on 2 successive
days, produced 50 ml. of almost pure blood. All
routine laboratory tests for bleeding diatheses and
arthritis were normal, as were roentgenograms. A
positive contrast arthrogram was normal, and
femoral arteriography provided no additional information.
On the basis of the characteristic history and
by exclusion of other causes of hemarthrosis, a
diagnosis was made of synovial hemangioma of
the right knee, and this was confirmed at operation when a 2 x 2 X 1.5 cm., bright red, “raspberry” lesion was found immediately upon entering
the joint through a medial parapatellar incision
(Fig. 1). The lesion was excised with a small
margin of normal synovium. Postoperative recovery
of joint function was satisfactory, and in the succeeding 20 months there has been no episode of
pain and swelling in the knee.
Pathological examination showed that the excised tissue was 2.5 cm.across and 1.5 cm.thick,
and consisted of a poorly circumscribed 1 cm.
nodule of pink, firm tissue surrounded by fat. The
interior of the nodule was filled with dark red,
clotted blood. As seen in histological preparations,
the bulk of the nodule was made up of tortuous,
Fig. 1.-Operative
(arrow).
photograph of lesion
distended, venous channels containing occasional
clumps of erythrocytes (Fig. 2). Some segments
of the vein walls were thickened by organized
adherent thrombus, and there were areas of recent
hemorrhage together with old blood pigment in
the intervening areolar connective tissue. The surface of the nodule was covered with hyperplastic,
chronically inflamed synovial membrane.
Synovial hemangioma is a rare cause of recurrent hemarthrosis. This case, remarkable because a firm preoperative diagnosis was made, is
reported here.
JACKSTEVENS,M.D.
PAULL. KATZ, M.D.
L. ARC-,
M.D.
FRANCIS
DANIELJ. MCCARTY,
M.D.
Chicago, Illinois
648
COMMUNICATIONS
Fig. 2.-Low-power
right. H E X 75.
+
photomicrograph of resected specimen. Synovial surface to the
REFERENCES
1. Bennett, G. E., and Cobet, M. C.: Hemangioma of joints. Arch. Surg. 38:487, 1969.
2. Brodsky, A. E.: Synovial hemangioma of the
knee joint. Bull. N.Y. Hosp. Joint Dis. 175.8,
1956.
3. Calcani, V.: On articular hemangioma of the
knee. Minerva Ortop. 16:84, 1965.
4. Coventry, M. B., Harrison, E. G., Jr., and
Martin, J. F.: Benign synovial tumors of the knee,
a diagnostic problem. J. Bone Joint Surg. 48A:
1350, 1966.
5. DePalma, A. F., and Mauler, G. C.: Hemangioma of synovial membrane. Clin. Orthop.
32:93, 1964.
6. Engelmann, A.: A contribution on knee joint
hemangioma. Chir. (Berlin) 37:83, 1966.
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7. Goidanich, I. F., Campanacci, M., and
Bedogni, C.: Intra-articular vascular hamartomas,
a study of 11 cases. L a c k . organ. Movim. 52:
351, 1964.
8. Izvekov, A. T.: Two cases of hemangioma of
the synovial membrane of the knee. Khir. 39:102,
1963.
9. Jacobs, J. E., and Lee, F. S.: Hemangioma
of the knee joint. J. Bone Joint Surg. 31A:831,
1949.
10. Jaffe, H. L.: Tumors and tumorous conditions of bone and joints. Philadelphia, Lea &
Febiger, 1958.
11. Karlholm, S., and Stjernsward, J.: Heman-
649
gioma of the knee joint. Acta Orthop. Scand. 33:
306, 1963.
12. Kuczynski, W.: Cavernous hemangioma of
the synovial membrane of the knee. Chir. Nan.
Ruchu Ortop. Polska 33:255, 1967.
13. Lewis, R. C., Jr., Coventry, M. B., and
Sode, E. H.: Hemangioma of the synovial membrane. J. Bone Joint Surg. 41A:2&4, 1959.
14. Osgood, R. B.: Tuberculosis of the knee
joint; angioma of the knee joint. Surg. Clin. N.
h e r . 1:665, 1921.
15. Thomas, C. F., and Evarts, C. M.: Cavemo m hemangioma of the synovial membrane of the
knee joint. Cleveland Clin. Quart. 32:223, 1965.
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