Unusual lesions that distend the knee joint: pictorial essay

The high number of knee imaging exams at radiology clinics, together with the wide variety of knee disorders, calls for expanding the knowledge about the less common lesions seen in routine diagnostic practice. The purpose of this pictorial essay was to illustrate unusual lesions that distend the knee joint, selected by relevance and evaluated with multiple imaging modalities, including X-ray, computed tomography, and magnetic resonance imaging, as well as to perform a brief review of the literature.

Keywords:
Knee/pathology; Neoplasms/diagnosis; Computed tomography; Magnetic resonance imaging

Authorship

Luana T. Barros de Lima Mailing address: Dra. Luana Lima. Avenida Brasil, 271, Poço. Maceió, AL, Brazil, 57025-070. E-mail: luanatbl@hotmail.com.

MD, Radiologist at Hospital Universitário Professor Alberto Antunes (HUPAA) - Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil.Universidade Federal de AlagoasBrazilMaceió, AL, BrazilMD, Radiologist at Hospital Universitário Professor Alberto Antunes (HUPAA) - Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil.

Eolo Santana de Albuquerque Filho

MD, Radiologist, Head of the Residency Program in Radiology and Diagnostic Imaging at Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.Universidade Federal de PernambucoBrazilRecife, PE, BrazilMD, Radiologist, Head of the Residency Program in Radiology and Diagnostic Imaging at Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.

Laecio Leitão Batista

PhD, Head of the Residency Program in Angiography and Endovascular Surgery at Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.Universidade Federal de PernambucoBrazilRecife, PE, BrazilPhD, Head of the Residency Program in Angiography and Endovascular Surgery at Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.

Talita Peixoto de Moraes

MD, Radiologist at Clínica Derbimagem, Recife, PE, Brazil.Clínica DerbimagemBrazilRecife, PE, BrazilMD, Radiologist at Clínica Derbimagem, Recife, PE, Brazil.

Bruno Perez Guedes Pereira

MD, Radiologist at the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil.Instituto de Medicina Integral Professor Fernando FigueiraBrazilRecife, PE, BrazilMD, Radiologist at the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil.

Mailing address: Dra. Luana Lima. Avenida Brasil, 271, Poço. Maceió, AL, Brazil, 57025-070. E-mail: luanatbl@hotmail.com.

SCIMAGO INSTITUTIONS RANKINGS

MD, Radiologist at Clínica Derbimagem, Recife, PE, Brazil.Clínica DerbimagemBrazilRecife, PE, BrazilMD, Radiologist at Clínica Derbimagem, Recife, PE, Brazil.

Figures

Figures (9)

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Figure 1
Synovial chondromatosis. Sagittal proton density (PD)-weighted MRI scans with fat suppression. Multiple intra-articular loose bodies located in the suprapatellar recess (arrow) and posterior recess (asterisk), where a popliteal cyst (Baker's cyst) can be seen.

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Figure 2
Intracapsular chondroma. CT scans acquired in the axial (A) and sagittal (B) planes. Expansile lesion with attenuation of soft tissues in the inferior and lateral regions to the patella, together with increased density of the infrapatellar (Hoffa's) fat pad.

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Figure 3
Intracapsular chondroma. PD-weighted, fat-suppressed MRI scans of the same patient depicted in Figure 2, acquired in the axial (A) and sagittal (B) planes. Heterogeneous expansile lesion (arrow) predominantly hyperintense with loculated borders associated with severe edema of the infrapatellar (Hoffa's) fat pad (asterisk), although with no signs of involvement of the adjacent bone.

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Figure 4
Lipoma arborescens. PD-weighted MRI sequences, both in the sagittal plane, with fat suppression (A) and without (B), showing intra-articular anomalous tissue, with a frond-like aspect, presenting a hyperintense signal in the PD-weighted sequences without fat suppression and showing a reduction in the signal strength when fat suppression is applied. Moderate joint effusion can also be seen.

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Figure 5
Lipoma arborescens. CT scans, both acquired in the axial plane. The anomalous tissue cited in Figure 4 shows hypoattenuation, indicating its adipose nature (arrows). Joint effusion can also be seen.

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Figure 6
Pigmented villonodular synovitis. PD-weighted MRI sequences, both in the sagittal plane, showing nodular synovial thickening interspersed with hypointense foci, especially in the suprapatellar and posterior recesses of the knee.

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Figure 7
Synovial sarcoma. Fat-suppressed T1-weighted MRI sequences in the axial (A) and sagittal (B) planes, after intravenous injection of paramagnetic contrast. Voluminous multiloculated expansile lesion, with the "bowl of grapes" aspect, showing intense enhancement after contrast administration. The femoral cortical bone (arrow) is poorly defined.

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Figure 8
Aneurysmal bone cyst of the patella. PD-weighted MRI sequences, both in the sagittal plane, with fat suppression (A) and without (B), showing heterogeneous multiloculated expansile lesion involving the patella. In the fat-suppressed sequences, fluid-fluid levels can be seen in some locules (arrow).

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Figure 9
Popliteal artery pseudoaneurysm. Sagittal PD-weighted MRI sequence (A) and sagittal fat-suppressed T1-weighted MRI sequence obtained after intravenous injection of paramagnetic contrast (B). Small bone projection from the tibial metaphysis (arrow) into the popliteal fossa, where there is an oval image with heterogeneous content, which shows partial enhancement by contrast, representing a partially thrombosed pseudoaneurysm.

Figure 1 Synovial chondromatosis. Sagittal proton density (PD)-weighted MRI scans with fat suppression. Multiple intra-articular loose bodies located in the suprapatellar recess (arrow) and posterior recess (asterisk), where a popliteal cyst (Baker's cyst) can be seen.

Figure 2 Intracapsular chondroma. CT scans acquired in the axial (A) and sagittal (B) planes. Expansile lesion with attenuation of soft tissues in the inferior and lateral regions to the patella, together with increased density of the infrapatellar (Hoffa's) fat pad.

Figure 3 Intracapsular chondroma. PD-weighted, fat-suppressed MRI scans of the same patient depicted in Figure 2, acquired in the axial (A) and sagittal (B) planes. Heterogeneous expansile lesion (arrow) predominantly hyperintense with loculated borders associated with severe edema of the infrapatellar (Hoffa's) fat pad (asterisk), although with no signs of involvement of the adjacent bone.

Figure 4 Lipoma arborescens. PD-weighted MRI sequences, both in the sagittal plane, with fat suppression (A) and without (B), showing intra-articular anomalous tissue, with a frond-like aspect, presenting a hyperintense signal in the PD-weighted sequences without fat suppression and showing a reduction in the signal strength when fat suppression is applied. Moderate joint effusion can also be seen.

Figure 5 Lipoma arborescens. CT scans, both acquired in the axial plane. The anomalous tissue cited in Figure 4 shows hypoattenuation, indicating its adipose nature (arrows). Joint effusion can also be seen.

Figure 6 Pigmented villonodular synovitis. PD-weighted MRI sequences, both in the sagittal plane, showing nodular synovial thickening interspersed with hypointense foci, especially in the suprapatellar and posterior recesses of the knee.

Figure 7 Synovial sarcoma. Fat-suppressed T1-weighted MRI sequences in the axial (A) and sagittal (B) planes, after intravenous injection of paramagnetic contrast. Voluminous multiloculated expansile lesion, with the "bowl of grapes" aspect, showing intense enhancement after contrast administration. The femoral cortical bone (arrow) is poorly defined.

Figure 8 Aneurysmal bone cyst of the patella. PD-weighted MRI sequences, both in the sagittal plane, with fat suppression (A) and without (B), showing heterogeneous multiloculated expansile lesion involving the patella. In the fat-suppressed sequences, fluid-fluid levels can be seen in some locules (arrow).

Figure 9 Popliteal artery pseudoaneurysm. Sagittal PD-weighted MRI sequence (A) and sagittal fat-suppressed T1-weighted MRI sequence obtained after intravenous injection of paramagnetic contrast (B). Small bone projection from the tibial metaphysis (arrow) into the popliteal fossa, where there is an oval image with heterogeneous content, which shows partial enhancement by contrast, representing a partially thrombosed pseudoaneurysm.

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