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    • #19785
      Xue Heng

      Hi, Steve.
      This patient was a 45-year-old male, with bilateral knee joint swelling for 2 years.
      He had no other evidence of rheumatologic diseases.
      US showed large effusion of knee joint, with echogenic protrusions inside the joint.
      Fist, I wonder how to distinguish synovitis and swelling fat pad.
      By their echo? Synovitis are hypoechoic and fat pad are echogenic?
      And can the echogenic protrusions in the case be Lipoma arborescens?
      Thank you very much, Steve.

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    • #19846
      Stephen Bird

      Nice example Xue,

      Personally I don’t think you can tell the difference with ultrasound.

      With synovitis you have synovial proliferation.
      With lipoma arborescens you have synovial proliferation just the same but containing more fat within it.

      So pretty similar.

      Both will have some Doppler signal.

      The lipomatous type will be a little more echogenic than the plain synovitis and your example is certainly echogenic.

      Lipoma arborescens is common in the knee so you have the correct location so I think it is likely to be the lipomatous type.

      Can I be 100% sure? not really.

      A CT or MRI will settle the debate gif it is warranted.

      Either way it is a benign condition


    • #19896
      Xue Heng

      Lipoma arborescens is a rare entity that I never diagnosed.
      Fat density or signal on CT or MRI will give a definite diagnosis.
      Thank you, Steve.

    • #19943
      Stephen Bird

      I agree Xue,

      It is rare and I never diagnose it with ultrasound.

      For me it just looks like synovial proliferation and it is likely to be a little more echogenic.

      The trouble is synovial proliferation in the knee is often echogenic so it requires CT or MRI to differentiate.


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