Hyperechoic lesion around medial meniscus

[Xue Heng]

Hi, Steve.
This is a case from Capital institute of pediatrics.
I have little experience in pediatrics MSK US. So I ask your help.
This is a 2-year-old girl complaining knee pain and cannot bear weight on this side.
US showed hyperechoic lesion around medial meniscus, with blurred margin.
Color Doppler showed little signal.
Because hemangioma is suspected, we compressed the lesion with probe.
But the lesion showed no shape change and no increased Color Doppler signal.
She had no history of injury.
The images below were longitudinal scan from the medial posterior knee.
What might be the possible diagnosis?
Thank you, Steve!

• This topic was modified 1 year, 10 months ago by Xue Heng.

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[Stephen Bird]

Hi Xue,

This one is tricky for me,

I am not sure what the answer is,

The medial joint line certainly has an anechoic area surrounded by an echogenic area.

The appearance is unfamiliar to me,

The growth plates look OK sonographically,

Plain radiographs and an MRI might be needed to be more specific,

I presume this appearance is unilateral and there is nothing similar on the other side.

It is a bit tricky for me to orientate on the images as well,

Is the MCL normal and this area seperate to it?

Was there a clinical swelling or skin changes?

The anechoic area seems adjacent to the meniscus, however i am not sure I have seen a para-meniscal cyst in a kid.

If you have any other images to share or x-ray,/ MRI information please share.

Steve

[Xue Heng]

Hi, Steve. Thank you for your answer!
Indeed, this appearance is unilateral and there is nothing similar on the other side.
There is no clinical swelling or skin changes.
The girl had operation, and the final pathological diagnosis was hemangioma.

[Stephen Bird]

Well there you go !

A haemangioma is a nice answer.

Interesting there was no flow with the Doppler, but some AVM’s have very slow flow and we don’t see it with Doppler.
Think of liver hemangioma’s and the way they behave with non contrast enhanced Doppler.

Great follow up,

I guess in retrospect when we think of children we should always have AVM on our differential list as they are common in that demographic.

It is echogenic and homogenous so I think it makes sense.

Thanks so much for posting this excellent case Xue,

Once again I have learn’t something from you.

Steve.

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