Hemangioma or synovial hemangioma ?

[Xue Heng]

Hi, Steve. Here is a case.
The patient was a 29-year-old female with fullness of posterior knee for 1 year.
A isoechoic intramuscular mass was observed, with blood flow on CDI.
The mass was soft and compressible and when I push the probe, increased blood flow was observed.
I think this is the typical hemangioma.
But one of my colleagues said that the mass could possiblely inside the joint, and should be synovial hemangioma.
How can we distinguish these two diseases with US?
Thank you very much.

Attachments:

You must be logged in to view attached files.

[Stephen Bird]

What muscle do you think it is in Xue?

It looks too superficial to be within the joint itself so I favour a mass outside the joint.

I agree it has characteristics consistent with a haemangioma with some venous lakes contained within it.

I agree this is the most likely diagnosis,

However you are still dealing with an unusual mass within a muscle (or between the muscles) so something sinister like a sarcoma still needs to be excluded.

I always think anything intramuscular that is not a standard post traumatic muscle tear needs cross sectional imaging workup just to be sure we are not missing a sarcoma.

I apply this to intramuscular lipomas was well.

Better be safe than sorry.

Steve

[Xue Heng]

I think the two muscles are medial gastrocnemius and semimembranosus muscle.
The patient undertook non-enhanced MRI before US, and the diagnosis was Baker’s cyst.
Considering the very soft and compressible nature of the mass, the diagnosis of sarcoma is unlikely, but it’s still worth taking enhanced MRI, as you said better be safe than sorry.
Thank you very much, Steve.

[Stephen Bird]

I do agree,

If it is a bakers cyst it has a lot of separations and debris which they can have.

The flow in it might just be fluid movement within the bakers cyst with transducer movement / compression.

If it is a bakers cyst there must have been some bleeding into the nee joint to some synovial proliferation process.

What did the supra patellar pouch look like?

Steve

[Xue Heng]

The supra patellar pouch looks normal with no synovial proliferation or fluid.

[Stephen Bird]

It is a tricky case,

I would expect the supra patellar pouch to show some signs of synovial disease if the bakers cyst is this complex.

Let us know what follow up you get Xue.

Steve

[Author]

Posts