Imaging characteristics of tenosynovial and bursal chondromatosis.

OBJECTIVES

Our purpose was to identify imaging characteristics of tenosynovial and bursal chondromatosis.

MATERIALS AND METHODS

We retrospectively reviewed 25 pathologically confirmed cases of tenosynovial (n = 21) or bursal chondromatosis (n = 4). Patient demographics and clinical presentation were reviewed. Imaging was evaluated by two musculoskeletal radiologists with agreement by consensus, including radiography (n = 21), bone scintigraphy (n = 1), angiography (n = 1), ultrasonography (n = 1), CT (n = 8), and MR (n = 8). Imaging was evaluated for lesion location/shape, presence/number of calcifications, evidence of bone involvement, and intrinsic characteristics on ultrasonography/CT/MR.

RESULTS

Average patient age was 44 years (range 7 to 75 years) with a mild male predilection (56%). A slowly increasing soft tissue mass was the most common clinical presentation (53%). Lesion locations included the foot (n = 8), hand (n = 6), shoulder (n = 3), knee (n = 2), ankle (n = 2) and one each in the upper arm, forearm, wrist, and cervical spine. All lesions were located in a known tenosynovial (21 cases, 84%) or bursal (four cases, 16%) location. All cases of bursal chondromatosis were round/oval in shape. Tenosynovial lesions were fusiform (65%) or round/oval (35%). Radiographs commonly showed a soft tissue mass (86%) and calcification (90%). Calcifications were predominantly chondroid (79%) or osteoid (11%) in character with >10 calcified bodies in 48%. CT detected calcifications in all cases. The intrinsic characteristics of the nonmineralized component showed low attenuation on CT (75%), high signal intensity on T2-weighted MR (76%) and a peripheral/septal contrast enhancement pattern (100%).

CONCLUSIONS

Imaging of tenosynovial and bursal chondromatosis is often characteristic with identification of multiple osteochondral calcifications (90% by radiographs; 100% by CT). CT and MR also revealed typical intrinsic characteristics of chondroid tissue and lesion location in a known tendon sheath or bursa.